Reward and motivation in pain and pain relief

E Navratilova, F Porreca - Nature neuroscience, 2014 - nature.com
Nature neuroscience, 2014nature.com
Pain is fundamentally unpleasant, a feature that protects the organism by promoting
motivation and learning. Relief of aversive states, including pain, is rewarding. The
aversiveness of pain, as well as the reward from relief of pain, is encoded by brain
reward/motivational mesocorticolimbic circuitry. In this Review, we describe current
knowledge of the impact of acute and chronic pain on reward/motivation circuits gained from
preclinical models and from human neuroimaging. We highlight emerging clinical evidence …
Abstract
Pain is fundamentally unpleasant, a feature that protects the organism by promoting motivation and learning. Relief of aversive states, including pain, is rewarding. The aversiveness of pain, as well as the reward from relief of pain, is encoded by brain reward/motivational mesocorticolimbic circuitry. In this Review, we describe current knowledge of the impact of acute and chronic pain on reward/motivation circuits gained from preclinical models and from human neuroimaging. We highlight emerging clinical evidence suggesting that anatomical and functional changes in these circuits contribute to the transition from acute to chronic pain. We propose that assessing activity in these conserved circuits can offer new outcome measures for preclinical evaluation of analgesic efficacy to improve translation and speed drug discovery. We further suggest that targeting reward/motivation circuits may provide a path for normalizing the consequences of chronic pain to the brain, surpassing symptomatic management to promote recovery from chronic pain.
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