Neuroimaging of pain: A psychosocial perspective
The past 60 years has witnessed major changes in the way that pain is conceptualized and treated. In the 1950s, pain was generally conceptualized using a sensory model that maintained that pain is a simple sensory event that warned of tissue damage. Treatments for pain were biomedical and consisted mainly of attempts to identify underlying tissue damage and treat it medically or surgically. In the 1960s, clinicians and researchers expressed growing dissatisfaction with the sensory model of pain. In particular, it became increasingly clear that the sensory model failed to explain phenomena often seen in patients experiencing chronic pain: pain persisting despite multiple medical and surgical treatments aimed at correcting underlying tissue damage, reports of pain showing poor correlation with underlying evidence of tissue damage, pain being modified by psychosocial factors such as anxiety, social support, or expectations. Melzack and Wall's gate control theory was one of the first to maintain that pain was complex in that it not only had a sensory component but also affective,-cognitive, and behavioral components (Science 150(699):971-979, 1965). A key tenet of the gate control theory was that the brain could play a major role in modulating nociceptive signals at the spinal cord, through descending pathways from brain areas thought to be involved in affect, cognition, and behavior. The gate control theory also led to renewed interest in expanding pain treatments beyond traditional medical and surgical approaches to a wide array of-interventions that could alter pain by modifying sensation (e.g.,-transcutaneous nerve stimulation, massage), or affective (e.g., antianxiety and antidepressant medications), cognitive (e.g., cognitive therapy, distraction techniques), and behavioral processes (e.g., exercise, graded activation). © 2011 Springer Science+Business Media, LLC.
Somers, TJ; Moseley, GL; Keefe, FJ; Kothadia, SM
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