Exploring the potential role of mesocorticolimbic circuitry in motivation for and adherence to chronic pain self-management interventions. (March 2019)

• Record Type: Journal Article
• Authors: Letzen, Janelle E.; Seminowicz, David A.; Campbell, Claudia M.; Finan, Patrick H.
• Is Part Of: Neuroscience and biobehavioral reviews. Volume 98(2019)
• Page Start: 10
• Page End: 17
• Publication Date: 2019-03
• Subjects: Mesocorticolimbic system -- Chronic pain -- Motivational Model for Pain Self-Management -- Treatment adherence -- Behavioral pain management; Psychophysiology -- Periodicals; Human behavior -- Periodicals; Animal behavior -- Periodicals; Neurology -- Periodicals; Behavior -- Periodicals; Ethology -- Periodicals; Neurology -- Periodicals; Psychophysiologie -- Périodiques; Comportement humain -- Périodiques; Animaux -- Mœurs et comportement -- Périodiques; Neurologie -- Périodiques; Animal behavior; Human behavior; Neurology; Psychophysiology; Periodicals; Electronic journals; 573.8
• DOI: 10.1016/j.neubiorev.2018.12.011
• Languages: English
• ISSNs: 0149-7634

Abstract

Highlights: Adherence to chronic pain interventions requiring lifestyle changes is challenging. Mesocorticolimbic function is related to motivation, a key predictor of adherence. Chronic pain patients demonstrate altered mesocorticolimbic function and anhedonia. This system's dysfunction might result in difficulty adhering to pain interventions. We offer a neurobehavioral model of pain, mesocorticolimbic function, and adherence. Abstract: Adherence to pain self-management strategies is associated with favorable psychobehavioral outcomes among individuals with chronic pain. Substantive adherence to treatments teaching these adaptive skills often proves challenging, resulting in poor individual and societal outcomes. Evidence demonstrates motivation for behavior change as a key predictor of treatment adherence. Despite behavioral techniques that target motivation, however, nonadherence persists as a barrier to positive clinical outcomes in chronic pain. Understanding the neurobiological mechanisms underlying treatment motivation might highlight novel avenues for augmentative therapies. The purpose of this review is to present theory and evidence that the mesocorticolimbic system (i.e., brain circuitry associated with reward processing and motivation) contributes to treatment motivation among chronic pain patients, ultimately influencing adherence. We review evidence for motivation as a key adherence determinant, detail neuroimaging findings relating mesocorticolimbic circuitry and motivation, and discuss data supporting mesocorticolimbic dysfunction among chronic pain patients. We propose a neurobehavioral model for adherence to pain self-management interventions, listing testable hypotheses. Finally, we discuss potential research and intervention implications from the proposed model.