The sensory, affective, and cognitive experience of chronic pain

Image from Gary Deng, Medical Director of MSK Integrative Medicine Service

While listening to a lecture by Jun J. Mao of Memorial Sloan Kettering Cancer Center on the topic of acupuncture for cancer-related pain, I was struck by a comment about the areas of the brain that have been demonstrated to respond to acupuncture --

"[Acupuncture] not only stimulates […] somatosensory areas correlated with the needling area, but most importantly [also stimulates] the limbic system affecting cognition and emotion. As we know chronic pain is not just the physical experience of pain, but is also the psychological and cognitive experience of pain. [This is] probably why acupuncture can be a very effective tool in controlling both acute and chronic pain."

This comment was in reference to a systematic review and meta-analysis of fMRI studies done by Claudia M. Witt's group, which concluded that "Brain response to acupuncture stimuli encompasses a broad network of regions consistent with not just somatosensory, but also affective and cognitive processing."

Chronic pain -- where pain persists beyond the physical healing process -- has been described as a disorder of the central nervous system, leading to multiple network activation involving sensory, emotional, cognitive, and behavioral changes. 

As a clinician I see patients' quality of life improve in ways that go beyond just their reported reduction in pain. It is interesting to reflect on that in the context of the quote above, and the fMRI evidence of changes in sensory, affective, and cognitive areas of the brain.

Pain is more than just a physical experience, and full recovery from chronic pain involves more than just a lower number on a 0-10 Likert scale!

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