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Chronic Headaches and the Neurobiology of Somatization

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Abstract

Pain sensitivity is an adaptive process affected by expectation, mood, coping, operant conditioning, and the preconscious allocation of attention. Underlying mechanisms may include encoding of similar experiences (eg, depression, loss, pain-distress) in overlapping patterns of activation, failure of common regulatory mechanisms, direct top-down activation of the pain matrix, and changes in descending pain facilitatory and inhibitory tone. In theory, the combination of glial cell activation from psychological stress and neural firing from nociceptive input may be particularly likely to lead to pain sensitization and long-term structural changes in pain processing regions of the brain. In these ways, headaches in which chronicity, diffuseness, and distress seem better accounted for by psychological than by medical variables can be understood in neurobiological terms. This can allow psychological treatment of physical distress to be objective, nonthreatening, and relatively precise.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Adair MJ: Plato’s lost theory of hysteria. Psychoanal Q 1997, 66:98–106.

    CAS  PubMed  Google Scholar 

  2. Kirmayer LJ, Sartorius N: Cultural models and somatic syndromes. Psychosom Med 2007, 69:832–840.

    Article  PubMed  Google Scholar 

  3. Legrain V, Van Damme S, Eccleston C, et al.: A neurocognitive model of attention to pain: behavioral and neuroimaging evidence. Pain 2009, 144:230–232.

    Article  PubMed  Google Scholar 

  4. Bantick SJ, Wise, RG, Ploghaus A, et al.: Imaging how attention modulates pain in humans using functional MRI. Brain 2002, 125:310–319.

    Article  PubMed  Google Scholar 

  5. Rainville P, Bao QV, Chrétien P: Pain-related emotions modulate experimental pain perceptions and autonomic responses. Pain 2005, 118:306–318.

    Article  PubMed  Google Scholar 

  6. Branstetter-Rost A, Cushing C, Douleh T: Personal values and pain tolerance: does a values intervention add to acceptance? J Pain 2009, 10:887–892.

    Article  PubMed  Google Scholar 

  7. Benedetti F, Lanotte M, Lopiano L, Colloca L: When words are painful: unraveling the mechanisms of the nocebo effect. Neuroscience 2007, 147:260–271.

    Article  CAS  PubMed  Google Scholar 

  8. •• Wiech K, Tracey I: The influence of negative emotions on pain: behavioral effects and neural mechanisms. NeuroImage 2009, 47:987–994. This article presents a comprehensive review of the brain imaging literature linking negative affect to pain.

    Article  PubMed  Google Scholar 

  9. Brown CA, Seymour B, El-Deredy W, Jones AK: Confidence in beliefs about pain predicts expectancy effects on pain perception and anticipatory processing in right anterior insula. Pain 2009, 139:324–332.

    Article  Google Scholar 

  10. • Goffaux P, Redmond WJ, Rainville P, Marchand S: Descending analgesia: when the spine echoes what the brain expects. Pain 2007, 130:137–143. This article offers a particularly striking demonstration of how a cognitive variable can influence nociceptive processing on the spinal level.

    Article  PubMed  Google Scholar 

  11. Holroyd KA, Labus JS, Carlson B: Moderation and mediation in the psychological and drug treatment of chronic tension-type headache: the role of disorder severity and psychiatric comorbidity. Pain 2009, 143:213–222.

    Article  PubMed  Google Scholar 

  12. Sullivan MJL, Thorn B, Haythornthwaite JA, et al.: Theoretical perspectives on the relation between catastrophizing and pain. Clin J Pain 2001, 17:52–64.

    Article  CAS  PubMed  Google Scholar 

  13. Crombez G, Eccleston C, Bayens F, Eelen P: When somatic information threatens, catastrophic thinking enhances attention interference. Pain 1998, 75:187–198.

    Article  CAS  PubMed  Google Scholar 

  14. •• Campbell CM, Edwards RR: Mind-body interactions in pain: the neurophysiology of anxious and catastrophic pain-related thoughts. Transl Res 2009, 153:97–101. This article is a concise, comprehensive review of the likely neural mechanisms by which catastrophization influences pain.

    Article  PubMed  Google Scholar 

  15. Rhudy JL, France CR, Bartley EJ, et al.: Does pain catastrophizing moderate the relationship between spinal nociceptive processes and pain sensitivity? J Pain 2009, 10:860–869.

    Article  PubMed  Google Scholar 

  16. Keefe FJ, Brown GK, Wallston KA, Caldwell DS: Coping with rheumatoid arthritis pain: catastrophizing as a maladaptive strategy. Pain 1989, 37:51–56.

    Article  CAS  PubMed  Google Scholar 

  17. Picavet HS, Vlaeyen JW, Schouten JS: Pain catastrophizing and kinesiophobia: predictors of chronic low back pain. Am J Epidemiol 2002, 156:1028–1034.

    Article  PubMed  Google Scholar 

  18. Edwards RR, Smith MT, Stonerock G, Haythornthwaite JA: Pain-related catastrophizing in healthy women is associated with greater temporal summation of and reduced habituation to thermal pain. Clin J Pain 2006, 22:730–737.

    Article  PubMed  Google Scholar 

  19. Weissman-Fogel I, Sprecher E, Pud D: Effects of catastrophizing on pain perception and pain modulation. Exp Brain Res 2008, 186:79–85.

    Article  PubMed  Google Scholar 

  20. Seminowicz DA, Davis KD: Cortical responses to pain in healthy individuals depends on pain catastrophizing. Pain 2006, 120:297–306.

    Article  PubMed  Google Scholar 

  21. •• Milligan ED, Watkins LR: Pathological and protective roles of glia in chronic pain. Nat Rev Neurosci 2009, 10:23–36. This article presents a clear review of how glial cell activation contributes to nociceptive transmission and central sensitization.

    Article  CAS  PubMed  Google Scholar 

  22. • García-Bueno B, Caso JR, Leza JC: Stress as a neuroinflammatory condition in brain: damaging and protective mechanisms. Neurosci Biobehav Rev 2008, 32:1136–1151. This intensive review describes how psychological stress activates glial cells.

    Article  PubMed  Google Scholar 

  23. • Schweinhardt P, Kuchinad A, Pukall CF, Bushnell MC: Increased gray matter density in young women with chronic vulvar pain. Pain 2008, 140:411–419. The authors integrate psychophysical, psychological, clinical, and brain morphometric data and review prior research.

    Article  CAS  PubMed  Google Scholar 

  24. Schmidt-Wilcke T, Leinisch E, Gänßbauer S, et al.: Affective components and intensity of pain correlate with structural differences in gray matter in chronic back pain patients. Pain 2006, 125:89–97.

    Article  CAS  PubMed  Google Scholar 

  25. George SZ, Wittmer VT, Fillingim RB, Robinson ME: Sex and pain-related psychological variables are associated with thermal pain sensitivity for patients with chronic low back pain. J Pain 2007, 8:2–10.

    Article  PubMed  Google Scholar 

  26. Ochsner KN, Ludlow DH, Knierim K, et al.: Neural correlates of individual differences in pain-related fear and anxiety. Pain 2006, 120:69–77.

    Article  PubMed  Google Scholar 

  27. Vaccarino AL, Sills TL, Evans KR, Kalali AH: Prevalence and association of somatic symptoms in patients with Major Depressive Disorder. J Affect Disord 2008, 110:270–276.

    Article  PubMed  Google Scholar 

  28. McFate T, Scher AI: Chronic pain disorders and headache chronification. Curr Pain Headache Rep 2009, 13:308–313.

    Article  PubMed  Google Scholar 

  29. Jenewein J, Moergeli H, Wittmann L, et al.: Development of chronic pain following severe accidental injury. Results of a 3-year follow-up study. J Psychosom Res 2009, 66:119–126.

    Article  PubMed  Google Scholar 

  30. Bär KJ, Brehm S, Boettger MK, et al.: Pain perception in major depression depends on pain modality. Pain 2005, 117:97–103.

    Article  PubMed  Google Scholar 

  31. Mayberg HS: Modulating dysfunctional limbic-cortical circuits in depression: towards development of brain-based algorithms for diagnosis and optimised treatment. Br Med Bull 2003, 65:193–207.

    Article  PubMed  Google Scholar 

  32. Strigo IA, Simmons AN, Matthews SC, et al.: Association of major depressive disorder with altered functional brain response during anticipation and processing of heat pain. Arch Gen Psychiatry 2008, 65:1275–1284.

    Article  PubMed  Google Scholar 

  33. Eisenberger NI, Inagaki TK, Rameson LT, et al.: An fMRI study of cytokine-induced depressed mood and social pain: the role of sex differences. NeuroImage 2009, 47:881–890.

    Article  PubMed  Google Scholar 

  34. Eisenberger NI, Jarcho JM, Lieberman MD, Naliboff BD: An experimental study of shared sensitivity to physical pain and social rejection. Pain 2006, 126:132–138.

    Article  PubMed  Google Scholar 

  35. Ehnvall A, Mitchell PB, Hadzi-Pavlovic D, et al.: Pain during depression and relationship to rejection sensitivity. Acta Psychiatr Scand 2009, 119:375–382.

    Article  CAS  PubMed  Google Scholar 

  36. Zubieta JK, Stohler CS: Neurobiological mechanisms of placebo responses. Ann N Y Acad Sci 2009, 1156:198–210.

    Article  CAS  PubMed  Google Scholar 

  37. Pizzagalli DA, Holmes AJ, Dillon DG, et al.: Reduced caudate and nucleus accumbens response to rewards in unmedicated individuals with major depressive disorder. Am J Psychiatry 2009, 166:702–710.

    Article  PubMed  Google Scholar 

  38. Brody AL, Saxena S, Stoessel P, et al.: Regional brain metabolic changes in patients with major depression treated with either paroxetine or interpersonal therapy. Arch Gen Psychiatry 2001, 58:631–640.

    Article  CAS  PubMed  Google Scholar 

  39. Johnstone T, van Reekum CM, Urry HL, et al.: Failure to regulate: counterproductive recruitment of top-down prefrontal-subcortical circuitry in major depression. J Neurosci 2007, 27:8877–8884.

    Article  CAS  PubMed  Google Scholar 

  40. Lorenz J, Minoshima S, Casey KL: Keeping pain out of mind: the role of the dorsolateral prefrontal cortex in pain modulation. Brain 2003, 126:1079–1091.

    Article  CAS  PubMed  Google Scholar 

  41. Dinan TG: Inflammatory markers in depression. Curr Opin Psychiatry 2008, 22:32–36.

    Article  Google Scholar 

  42. Bigal ME, Ashina S, Burstein R, et al.: Prevalence and characteristics of allodynia in headache sufferers. A population study. Neurology 2008, 70:1525–1533.

    Article  CAS  PubMed  Google Scholar 

  43. Bigal ME, Lipton RB: What predicts the change from episodic to chronic migraine? Curr Opin Neurol 2009, 22:269–276.

    Article  PubMed  Google Scholar 

  44. Mongini F, Keller R, Deregibus A, et al.: Personality traits, depression and migraine in women: a longitudinal study. Cephalalgia 2003, 23:186–192.

    Article  CAS  PubMed  Google Scholar 

  45. McBeth J, Silman AJ, Gupta A, et al.: Moderation of psychosocial risk factors through dysfunction of the hypothalamic-pituitary-adrenal stress axis in the onset of chronic widespread musculoskeletal pain. Arthritis Rheum 2007, 56:360–371.

    Article  CAS  PubMed  Google Scholar 

  46. Urry HL, van Rekum CM, Johnstone T, et al.: Amygdala and ventromedial prefrontal cortex are inversely coupled during regulation of negative affect and predict the diurnal pattern of cortisol secretion among older adults. J Neurosci 2006, 26:4415–4425.

    Article  CAS  PubMed  Google Scholar 

  47. Scher AI, Stewart WF, Buse D, et al.: Major life changes before and after the onset of chronic daily headache: a population-based study. Cephalalgia 2008, 28:868–876.

    Article  CAS  PubMed  Google Scholar 

  48. Lee S: Diagnosis postponed: Shenjing shuairuo and the transformation of psychiatry in post-Mao China. Cult Med Psychiatry 1999, 23:349–380.

    Article  CAS  PubMed  Google Scholar 

  49. Kleinman AM: Neurasthenia and depression: a study of somatization and culture in China. Cult Med Psychiatry 1982, 6:117–190.

    Article  CAS  PubMed  Google Scholar 

  50. Lam K, Marra C, Salzinger K: Social reinforcement of somatic versus psychological description of depressive events. Behav Res Ther 2005, 43:1203–1218.

    Article  PubMed  Google Scholar 

  51. Gureje O: What can we learn from a cross-national study of somatic distress? J Psychosom Res 2004, 56:409–412.

    Article  PubMed  Google Scholar 

  52. Becker S, Kleinböhl D, Klossika I, Hölzl R: Operant conditioning of enhanced pain sensitivity by heat-pain titration. Pain 2008, 140:104–114.

    Article  PubMed  Google Scholar 

  53. Hölzl R, Kleinböhl D, Huse E: Implicit operant learning of pain sensitization. Pain 2005, 115:12–20.

    Article  PubMed  Google Scholar 

  54. Aybek S, Kanaan RA, David AS: The neuropsychiatry of conversion disorder. Curr Opin Psychiatry 2008, 21:275–280.

    Article  PubMed  Google Scholar 

  55. Cojan Y, Waber L, Carruzzo A, Vuilleumier P: Motor inhibition in hysterical conversion paralysis. NeuroImage 2009, 47:1026–1037.

    Article  PubMed  Google Scholar 

  56. Mailis-Gagnon A, Giannoylis I, Downar J, et al.: Altered central somatosensory processing in chronic pain patients with “hysterical” anesthesia. Neurology 2003, 60:1501–1507.

    CAS  PubMed  Google Scholar 

  57. Carhart-Harris RL, Mayberg HS, Malizia AL, Nutt D: Mourning and melancholia revisited: correspondences between principles of Freudian metapsychology and empirical findings in neuropsychiatry. Ann Gen Psychiatry 2008, 7:1–23.

    Article  Google Scholar 

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Acknowledgment

This article is dedicated to the memory of Ira M. Lipsky (1947–2008), cofounder of the Chronic Pain Program at Maine General Medical Center.

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No potential conflict of interest relevant to this article was reported.

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Correspondence to Jonathan M. Borkum.

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Borkum, J.M. Chronic Headaches and the Neurobiology of Somatization. Curr Pain Headache Rep 14, 55–61 (2010). https://doi.org/10.1007/s11916-009-0084-z

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