The essay discusses the approach of cognitive factors in influencing the perception of pain. Painisacompoundbiopsychosocialphenomenonthatbeginsby the communication of various neuroanatomic and neurochemical systems with numerouscognitiveandaffective activities. There is big inter-individual as well as intra-individual variances in pain perception varying on the basis of circumstance and implication of the pain.Different pathways and theregionsofbrain involved are also examined to understand the process and make associations with the correlated activities.The essay reviews various studies on differentaspectsofthe pain perception through cognitive factors. Further analysis is done to evaluate the discussion. The somatic, cognitive,emotionalandbehavioural effects on pain perception are discussed briefly to draw a comparison. The essay is concluded with the summary of the discussion and limitations of the researches in this field.
A study was conducted to study the cerebral signature for pain perception and its modulation. The study was done to understand the process of pain at both cellular and system levels. The study discussed that brainstem descending modulatory complex with its pro- and antinociceptivemechanisms has a vital role to play in allowing the extent of nociceptive transmission and in turn managing that the subsequent pain experienced is suitable for the specificcondition of the individual. The study suggested that the factors affecting pain perception are centrally mediated and striking a balance between peripheral andcentral effects and establishing which are due to pathological or cognitive influences will assist in treatment therapies.
The literature went on to describe the pain matrix which basically has lateral (sensory-distinguishing) and medial (affective-cognitive-calculative) structural elements. Various cognitive factors like attention, context, and mood are reviewed separately and have been proven to affect the pain perception. the extent of the pain stimulus to which it is defined as emotional and consequently yields an emotional state is based on the actions performed in various areas like amygdala, insular, ventral striatum, ACC, and hippocampus, as well as the PFC.But the role of the influence of emotional and cognitive influences such as anxiety, or depression on pain perception in the descending pain modulatory system is yet to be determined. The study has limitations as Understanding the role of complex behavioural influences and cognition in pain perception in animals is difficult to evaluate due to the shortage of sophisticated behaviouralprototypesand dependency on inception or retracting measures.(Mantyh & Patrick, 2007)
A study was done to assess the cognitive and emotional regulation of pain and its interference in chronic pain. The study discussedthe mechanisms involved in the variation of pain bycognitive and psychological elements. The study also indicated the recent evidence that reveal that persistent pain can precede to structural and physiological modifications in the mechanism concerned with the psychological alteration of pain perception, causing not only pain but also in changed cognition(Peters, 2015). Different effects of attention and emotion on pain experience and the stimulation of relevant cortical regions on pain stimulusproposes that differentiate altering systems may be responsible for theattentional and emotional influences on pain perception.Projections from the midbrain PAG to brainstem nuclei,involving the rostroventral medulla and the locus coeruleus, to the dorsal horn of the spinal cord are the usually reviewed pain modulatory mechanisms. Thesemechanismscontainendogenous opioids, noradrenaline and serotonin, and perform inhibition as well as excitation actions on spinal cord afferent projection neurons(Voisin, 2005).
The question arises that when cognitivefactors can initiate modulatory pathway in brain areas and result in structuraldeviationsdue to chronic pain, then can psychological treatment therapies reverse changes of the brain linkedwith chronic pain.The regions of brain that are involved in the descending modulatory system are not only responsiblefor pain but also for cognitive and emotionalperformance of the individual (Pessoa, 2008). Thus, the development of cognitive insufficiencies as well as anxiety disorders and depression in patients of long-term chronic pain can be explained by the fact that workingof areas of the brainoccupiedin both painregulation and cognitive working is similar.However, the sequentialconnectionbetween pain, cognitive insufficiencies, GAD and depression ishardtoascertain.(Bushnell & Low, 2015)
Another study discussed the psychobiological intervention of nociception and pain. This study suggested inferences for clinical practice for individuals dealing with chronic pain, and offered sound justification for evaluating and treating pain from a biopsychosocial view point. A part from the somatosensory components of pain perception, cognitive and emotional factors are implied when pain is defined. Pain perception comprises of various psychological processes, involving attention positioning to the pain stimulus, cognitive review of the implication of the stimulus, and the resultant emotional, psychophysiological, and behavioural response, which then follows a feedback mechanism to affect pain perception.
One of the practices that comprise pain perception isin which individual subjectively assess the purpose of sensory stimulusradiating from the body to regulate the magnitude to which they indicate the existence of a real or possible damage. The intrinsicinconsistencyof cognitiveevaluation of pain may resultfrom the neurobiologicaldetachmentbetween the sensory andemotionalattributes of the pain perception. Intensitymodulation of pain occurs due tomodified initiation of somatosensory cortex, while unpleasantness modulation of pain occurs due to modified initiation of the anterior cingulate cortex. Thus, in spite of a constant intensity stimulus,a sensory signalactivated from the neck muscles might besensed as warmth, or perceivedas asevere distress.
When pain perception is distinguishes asmanageable, the intensity of pain is reduced without any action from individual’s side to regulate the pain. The region of brain responsible for determining the extent to which pain is perceived as manageable is ventrolateral prefrontal cortex. Also, itsactivation is negatively associated with subjective pain intensity (Garland, 2013).
Pain is a cognizant occurrence, an understanding of the nociceptive input affected by memories, behavioural, pathological, inherited, and cognitive factors. The resulting pain is not always linearly linked to the nociceptive input. Pain is an unpleasant, sensory and subjective experience accompanied by definite or potential tissue injury. Cognitive and emotional effects comprise of a complicated emotional experience that depends on every individual (Fosam, 2016). The antagonistic character of pain produces a strong psychological reaction that feeds back to alter pain perception. Pain often occurs due to emotions of anger, grief, and worrybased on the how the pain is cognitively evaluated.
One of the coping mechanisms of pain is distraction. It is found that the perception of pain can be weakened if the subject does cognitive tasks or distracted (Seminowicz & Mikulis, 2004).It is also confirmed by a study that even while perceiving mild to moderate pain, cognition-basedactions areslightly affected, and individuals asked to finish an activity, will be able to do so in spite of the pain (Davis & Seminowicz, 2007). The initiation and operational link between the downward pain control systems involves the dorsolateral prefrontal cortex, the rostral anterior cingulate cortex, and periaqueductal gray. This link is directly related to pain relief, decreasesinitiation of other pain-related areas of the brain, and is believed to also affect the cognitive influences such as distraction, all of which participate in pain relief(Eippert, 2009)
The efficiency of pain treatment is also determined by the emotional state of the subject.A negative psychological state and reduced anticipation of treatment success can multiply the intensity of the pain perception, and diminish the analgesic effect of an opioid analgesic. On the contrary, a positive psychological state and anoptimistic anticipation of treatment success can decrease pain and augment clinical effect of the analgesic.The potential clinical effects of the cognitive factors on pain perception can be utilised to voluntarily influence and usedas part of a pain treatment therapy to attainessential and utmost pain relief is still a question.
Pain perception is a highly subjective phenomenon involving different brain regions and various processes. Pain relief through distraction, educational mediation and vocal manipulation suggests the strong influence of cognition on pain perception and offers a perspective to understand the methods of placebo analgesia.This field demands more research to gain a better understanding of theinfluence of cognitive factors on pain perception.Thekind of the stimulus and the factors that can stop the cognitive pain modulation are also uncertain. The cognitive factors and the process of perception that gives materialise to the experience of pain are also not very well understood. Further study is also required to direct the creation of a rational model that integrates cognitive and neuroimaging evidence, so that all traits of cognitive modulation, including its activation, execution, and regulation can be addressed.
Bushnell, C., & Low, M. ?. (2015, June 14). Cognitive and emotional control of pain and its disruption in chronic pain. Nat Rev Neurosci, 14(7), 502-511.
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Eippert, F. B. (2009). Direct evidence for spinal cord involvement in placebo analgesia. Science, 326(5951), 404.
Fosam, H. (2016, November 8). The Influence of Cognitive Processes on Pain Perception. Retrieved December 5, 2017, from Clinical Pain Advisor: https://www.clinicalpainadvisor.com/chronic-pain/deconstructing-the-sensation-of-pain/article/573823/
Garland, E. L. (2013, September 1). Pain Processing in the Human Nervous System: A Selective Review of Nociceptive and Biobehavioral Pathways. Prim Care, 39(3), 561-571.
Mantyh, W., & Patrick, I. T. (2007, August 2). The Cerebral Signature for Pain Perception and Its Modulation. Neuron, 55(3), 377-391.
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Peters, M. L. (2015). Emotional and Cognitive Influences on Pain Experience. Mod Trends Pharmacopsychiatry, 138-152.
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Voisin, G. C. (2005). Nociceptive stimulation activates locus coeruleus neurones projecting to the somatosensory thalamus in the rat. The Journal of Physiology, 566(3), 929–937