• Marwan N Baliki and A Vania Apkarian.
• Department of Physiology, Feinberg School of Medicine, 303 East Chicago Avenue, Chicago, IL 60610, USA. Electronic address: m-baliki@northwestern.edu.
• Neuron. 2015 Aug 5;87(3):474-91.

AbstractRecent neuroimaging studies suggest that the brain adapts with pain, as well as imparts risk for developing chronic pain. Within this context, we revisit the concepts for nociception, acute and chronic pain, and negative moods relative to behavior selection. We redefine nociception as the mechanism protecting the organism from injury, while acute pain as failure of avoidant behavior, and a mesolimbic threshold process that gates the transformation of nociceptive activity to conscious pain. Adaptations in this threshold process are envisioned to be critical for development of chronic pain. We deconstruct chronic pain into four distinct phases, each with specific mechanisms, and outline current state of knowledge regarding these mechanisms: the limbic brain imparting risk, and the mesolimbic learning processes reorganizing the neocortex into a chronic pain state. Moreover, pain and negative moods are envisioned as a continuum of aversive behavioral learning, which enhance survival by protecting against threats.Copyright © 2015 Elsevier Inc. All rights reserved.

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