Chronic pain is one of the largest medical health problems in Europe, affecting about 20% of all adults. To combat chronic pain, we need an improved understanding of the mechanisms underpinning pain. We know that pain is not an invariant mapping from the physical intensity of sensory stimulation to perception, but is subject to various modulating factors that reduce or enhance pain perception. Endogenous pain modulation involves systems that originate in cortical areas, which communicate – via subcortical and brainstem structures – with the spinal cord, where nociceptive processing is controlled. Previous research has focused on anti-nociceptive mechanisms, but it is becoming increasingly clear that pro-nociceptive mechanisms also play an important role in chronic pain.
This proposal will therefore be investigating the neurobiological mechanisms that underlie both directions of pain modulation, by using the models of placebo analgesia and nocebo hyperalgesia in functional magnetic resonance imaging (fMRI) and magnetoencephalography (MEG) studies. A first objective is to investigate bidirectional brainstem control of spinal cord responses with dedicated fMRI tools. The second objective – which involves ultra high-field fMRI – is to characterize the subcortical-brainstem networks in detail that intervene between cortical and spinal processing. Finally, a third objective is to determine cortical pain control mechanisms by using MEG in combination with analysis of evoked and induced responses. All three objectives will put a strong emphasis on connectivity analyses.
The proposal will provide important insights into pro- and anti-nociceptive pain-modulatory processes at an unprecedented level of detail. Such an endeavor is clinically important, as malfunction of pain control systems is a key underlying factor in the generation and maintenance of chronic pain, which is an enormous burden not only for the affected individual, but also for health-care systems worldwide.
Fields of science
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