The role of learning, stress and underlying brain circuits involving prefrontal-limbic interactions in the development of chronic back pain

Previous research led to the assumption that emotional learning may play a major role in the development of chronic pain, with a special role for operant and respondent conditioning mechanisms. While a number of studies have shown that psychosocial factors predict persistent pain, little is known how these relate to altered learning processes, and about the associated changes in brain structure and function that might predict persistent pain. Moreover, respondent and operant learning processes may interact with the experience of stress, which can alter pain processing and pain-related brain circuits. Goals: This project seeks to predict the transition from acute to chronic back pain and to disentangle risk and resilience factors by determining maladaptive operant and respondent appetitive and aversive learning mechanisms in pain, their modulation by stress and the underlying brain circuits. Methods: We will use functional magnetic resonance imaging (MRI) techniques and experimental psychology methods to identify specific circuits involved in learning processes and employ resting state as well as structural MRI methods including diffusion tensor imaging in individuals at risk for back pain chronicity and follow them to the chronic state. We will use experimental procedures of aversive (fear) and appetitive (reward) pavlovian (respondent) conditioning as well as instrumental (operant) learning, and assess stress parameters at baseline as well as stress-induced stress-induced analgesia.

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