Cognitive and emotional control of pain and its disruption in chronic pain

Chronic pain is associated with changes in brain structure and function resulting in altered cognition and affect. Bushnellet al. examine the mechanisms underlying the psychological modulation of pain and the potential of mind–body therapies to alleviate chronic pain. Chronic pain is one of the most prevalent health problems in our modern world, with millions of people debilitated by conditions such as back pain, headache and arthritis. To address this growing problem, many people are turning to mind–body therapies, including meditation, yoga and cognitive behavioural therapy. This article will review the neural mechanisms underlying the modulation of pain by cognitive and emotional states — important components of mind–body therapies. It will also examine the accumulating evidence that chronic pain itself alters brain circuitry, including that involved in endogenous pain control, suggesting that controlling pain becomes increasingly difficult as pain becomes chronic.