The dynamic pain connectome

•A dynamic pain connectome represents pain variability encoded in brain communication. •Specific neural networks contribute to spontaneous pain–attention fluctuations. •Individual factors and attention contribute to pain connectome disruption in chronic pain. •Personalized pain therapies may emerge from study of the dynamic pain connectome. Traditionally, studies of how pain and attention modulate one another involved explicit cognitive-state manipulations. However, emerging evidence suggests that spontaneous brain-wide network communication is intrinsically dynamic on multiple timescales, and attentional states are in constant fluctuation. Here, in light of studies on neural mechanisms of spontaneous attentional fluctuations and pain variability, we introduce the concept of a dynamic ‘pain connectome’ in the brain. We describe how recent progress in our understanding of individual differences in intrinsic attention to pain and neural network dynamics in chronic pain can facilitate development of personalized pain therapies. Furthermore, we emphasize that the dynamics of pain–attention interactions must be accounted for in the contemporary search for a ‘neural signature’ of the pain connectome. Traditionally, studies of how pain and attention modulate one another involved explicit cognitive-state manipulations. However, emerging evidence suggests that spontaneous brain-wide network communication is intrinsically dynamic on multiple timescales, and attentional states are in constant fluctuation. Here, in light of studies on neural mechanisms of spontaneous attentional fluctuations and pain variability, we introduce the concept of a dynamic ‘pain connectome’ in the brain. We describe how recent progress in our understanding of individual differences in intrinsic attention to pain and neural network dynamics in chronic pain can facilitate development of personalized pain therapies. Furthermore, we emphasize that the dynamics of pain–attention interactions must be accounted for in the contemporary search for a ‘neural signature’ of the pain connectome. an increase in cognitive performance when painful stimuli are applied during an attention-demanding task. the endogenous control system of the brain that functions to attenuate nociceptive responses and decrease pain. the anatomical pathway that conveys nociceptive input from the peripheral nervous system to neurons in the spinal cord and brain. the full description of anatomical connections in the brain. a set of highly interconnected brain regions, including the mPFC and PCC/precuneus (core), and at least two subsystems anchored in the medial temporal lobe and dorsomedial prefrontal cortex, respectively. the spatiotemporal signature of brain network communication that represents the integration of all aspects of pain. a paradigm in which a subject is intermittently given thought probes to assess their subjective attentional state. the general tendency to attend to pain in the absence of any explicit manipulations or active efforts to modify the pain experience. an analysis of the relations among signals from different brain regions that typically involves machine-learning and pattern classification approaches to distinguish different conditions or individuals. a decrease in cognitive performance when painful stimuli are applied during an attention-demanding task. perseverative negative thinking about pain and its possible consequences.