Review Article
Volume 14 Issue 4 - 2022
Neuronal Mechanisms and Treatment Approaches to Emotional and Physical Pain

Rashad Roberson1, Nicholas A Kerna2,3*, John V Flores4,5, Sudeep Chawla6, Stephen M Brown7, Joseph Anderson II8, Hilary M Holets4,5, ND Victor Carsrud9, Uzoamaka Nwokorie10 and Kevin D Pruitt11,12

1Georgetown American University, College of Medicine, Guyana
2SMC-Medical Research, Thailand
3First InterHealth Group, Thailand
4Beverly Hills Wellness Surgical Institute, USA
5Orange Partners Surgicenter, USA
6Chawla Health & Research, USA
7International University of Health Sciences, St. Kitts
8International Institute of Original Medicine, USA
9Lakeline Wellness Center, USA
10University of Washington, USA
11Kemet Medical Consultants, USA
12PBJ Medical Associates, LLC, USA

*Corresponding Author: Nicholas A Kerna, (mailing address) POB47 Phatphong, Suriwongse Road, Bangkok, Thailand 10500. Contact:
Received: February 12, 2022; Published: March 30, 2022


The feeling of pain encompasses a range of mental and physical states, sharing the scale of mild annoyance to debilitation. Pain is the most common symptom reported to health care professionals. Psychological pain results from negative emotions induced by any feeling of loss. Physical pain is an aversive state that originates from an injury or disease. Pain is a complex and bio-psycho-social phenomenon, arising from interactions of anatomical and chemical systems of neural networks and involving several cognitive processes. Medicine still regards pain as a symptom of physical injury, despite evidence of many people suffering from psychologicalbased pain. The concept of pain requires broadening and inclusion to accommodate the basic science of pain originating from various sources, that is, physical and psychological. Research on emotional psychology and pain has proliferated in many aspects with overlapping and non-linear networks. Psychology could be an essential contributor to understanding and depicting chronic pain treatment approaches, as psychological illness and pain are viewed as a reciprocal relationship that involves the expression of the disease and the pain that showcases specific effects on the behavior and emotional state. Persistent pain is complex, with emotions only scaling as a contributing factor supported by anecdotal evidence with the frequent association. Other factors such as genetic, environmental, contingencies, placebo, and cognition also play an essential role in studying the aspect. This review provides an overview of chronic and emotional pain and its underlying neuronal mechanisms and treatment approaches.

Keywords: Cognitive-Behavioral Therapy; Depression; Inflammation; Limbic System; Sickle Cell Disease; Osteoarthritis; Prostaglandins


  1. Lumley MA., et al. “Pain and Emotion: A Biopsychosocial Review of Recent Research”. Journal of Clinical Psychology9 (2011): 942-968.
  2. IM SW., et al. “Gunshot Wounds and Other Injuries of Nerves”. Lippincott. New York (1864).
  3. Sudeck P. “Über die akute (reflektorische) Knochenatrophie nach Entzündungen und Verletzungen in den Extremitäten und ihre klinischen Erscheinungen”. Fortschr Röntgenstr 5 (1901): 227-293.
  4. J A Evans. “Reflex sympathetic dystrophy”. Surgical Clinics of North America 26 (1946): 780-790.
  5. Edwin S Shneidman. “The Suicidal Mind”. Oxford University Press, New York (1996).
  6. Sandler J. “Psychology and psychoanalysis”. British Journal of Medical Psychology2 (1962): 91-100.
  7. Bakan D. “Disease, Pain, and Sacrifice”. Chicago: University of Chicago P (1968).
  8. Baumeister RF. “Suicide as an escape from self”. Psychological Review1 (1990): 90-113.
  9. Melzack R and Casey KL. “Sensory, motivational, and central control determinants of pain: a new conceptual model”. The Skin Senses 1 (1968): 423-439.
  10. Ploner M., et al. “Pain affect without pain sensation in a patient with a postcentral lesion”. Pain 1-2 (1999): 211-214.
  11. Kulkarni B., et al. “Attention to pain localization and unpleasantness discriminates the functions of the medial and lateral pain systems”. The European Journal of Neuroscience11 (2005): 3133-3142.
  12. Conejero I., et al. “Psychological Pain, Depression, and Suicide: Recent Evidences and Future Directions”. Current Psychiatry Reports5 (2018): 33.
  13. Pellegrini S., et al. “Scaling relative incentive value: Different adjustments to incentive downshift in pigeons and rats”. Behavioural Processes 3 (2008): 182-188.
  14. Papini MR., et al. “Behavioral neuroscience of psychological pain”. Neuroscience and Biobehavioral Reviews 48 (2015): 53-69.
  15. Fayaz A., et al. “Prevalence of chronic pain in the UK: a systematic review and meta-analysis of population studies”. BMJ Open6 (2016): e010364.
  16. Turk DC and Rudy TE. “Toward an Empirically Derived Taxonomy of Chronic Pain Patients: Integration of Psychological Assessment Data”. Journal of Consulting and Clinical Psychology2 (1988): 233-238.
  17. Tracey I and Bushnell MC. “How neuroimaging studies have challenged us to rethink: is chronic pain a disease?” The Journal of Pain11 (2009): 1113-1120.
  18. Ji RR., et al. “Neuroinflammation and central sensitization in chronic and widespread pain”. Anesthesiology2 (2018): 343-366.
  19. Gold MS and Gebhart GF. “Nociceptor sensitization in pain pathogenesis”. Nature Medicine11 (2010): 1248-1257.
  20. Basbaum AI., et al. “Cellular and molecular mechanisms of pain”. Cell2 (2009): 267-284.
  21. Latremoliere A and Woolf CJ. “Central sensitization: a generator of pain hypersensitivity by central neural plasticity”. The Journal of Pain9 (2009): 895-926.
  22. Hains BC and Waxman SG. “Activated microglia contribute to the maintenance of chronic pain after spinal cord injury”. The Journal of Neuroscience: The Official Journal of the Society for Neuroscience16 (2006): 4308-4317.
  23. Simons LE., et al. “Psychological Processing in Chronic Pain: A Neural Systems Approach”. Neuroscience and Biobehavioral Reviews 39 (2014): 61.
  24. Elman I., et al. “The missing p in psychiatric training: why it is important to teach pain to psychiatrists”. Archives of General Psychiatry1 (2011): 12-20.
  25. Borsook D., et al. “Reward-aversion circuitry in analgesia and pain: implications for psychiatric disorders”. European Journal of pain (London, England)1 (2007): 7-20.
  26. Bendelow GA and Williams SJ. “Transcending the dualisms: towards a sociology of pain”. Sociology of Health and Illness2 (1995): 139-165.
  27. Elman I., et al. “Pain and suicidality: insights from reward and addiction neuroscience”. Progress in Neurobiology 109 (2013): 1-27.
  28. Goldberg RT., et al. “Relationship between traumatic events in childhood and chronic pain”. Disability and Rehabilitation1 (1999): 23-30.
  29. Nicolson NA., et al. “Childhood maltreatment and diurnal cortisol patterns in women with chronic pain”. Psychosomatic Medicine5 (2010): 471-480.
  30. Miller LR and Cano A. “Comorbid chronic pain and depression: who is at risk?” The Journal of Pain6 (2009): 619-627.
  31. Ohayon MM and Schatzberg AF. “Chronic pain and major depressive disorder in the general population”. Journal of Psychiatric Research7 (2010): 454-461.
  32. Wiech K and Tracey I. “The influence of negative emotions on pain: behavioral effects and neural mechanisms”. NeuroImage 3 (2009): 987-994.
  33. Rhudy JL and Meagher MW. “Fear and anxiety: divergent effects on human pain thresholds”. Pain1 (2000): 65-75.
  34. Rhudy JL and Meagher MW. “Individual differences in the emotional reaction to shock determine whether hypoalgesia is observed”. Pain Medicine (Malden, Mass)3 (2003): 244-256.
  35. von Korff M and Simon G. “The Relationship Between Pain and Depression”. The British Journal of PsychiatryS30 (1996): 101-108.
  36. Leeuw M., et al. “The fear-avoidance model of musculoskeletal pain: current state of scientific evidence”. Journal of Behavioral Medicine1 (2007): 77-94.
  37. Sturgeon JA. “Psychological therapies for the management of chronic pain”. Psychology Research and Behavior Management 7 (2014): 115.
  38. Hayes SC., et al. “Acceptance and commitment therapy: model, processes and outcomes”. Behavior Research and Therapy1 (2006): 1-25.
  39. Pincus T and McCracken LM. “Psychological factors and treatment opportunities in low back pain”. Best Practice and Research Clinical Rheumatology5 (2013): 625-635.
  40. Day M., et al. “The Continuing Evolution of Biopsychosocial Interventions for Chronic Pain”. Journal of Cognitive Psychotherapy 2 (2012): 114-129.
  41. Turk DC. “The potential of treatment matching for subgroups of patients with chronic pain: lumping versus splitting”. The Clinical Journal of Pain1 (2005): 44-55.
  42. Turk DC., et al. “Differential responses by psychosocial subgroups of fibromyalgia syndrome patients to an interdisciplinary treatment”. Arthritis Care and Research: The Official Journal of the Arthritis Health Professions Association5 (1998): 397-404.
  43. Kerns RD., et al. “Readiness to adopt a self-management approach to chronic pain: the Pain Stages of Change Questionnaire (PSOCQ)”. Pain1-2 (1997): 227-234.
  44. Dimidjian S and Hollon SD. “How would we know if psychotherapy were harmful?” The American Psychologist1 (2010): 21-33.
  45. Vadivelu N., et al. “Pain and Psychology-A Reciprocal Relationship”. The Ochsner Journal2 (2017): 173-180.
  46. Wager TD., et al. “An fMRI-Based Neurologic Signature of Physical Pain”. New England Journal of Medicine15 (2013): 1388-1397.
  47. Melzack R. “Pain and the Neuromatrix in the Brain”. Journal of Dental Education12 (2001): 1378-1382.
Citation: Roberson R, Kerna NA, Flores JV, Chawla S, Brown SM, Anderson II J, Holets HM, Carsrud NDV, Nwokorie U, Pruitt KD. “Neuronal Mechanisms and Treatment Approaches to Emotional and Physical Pain”. EC Neurology 14.4 (2022): 28-37.

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