Central nervous system and psychophysiology of chronic pain

Abstract

T he focus article by Flor and Birbaumer proposes that chronic pain is the result of condit ioning in predisposed individuals. They support this thesis with data from chronicmusculoskeletal back pain patients. They state that condit ioning manifests with peripheral muscle tone changes and central electrocortical changes. Alterations of cortical processing measured by physiological techniques of electroencephalography (EEG) and magnetoencephalography (MEG) are used to demonstrate the contribution of the central nervous system (CNS) to the development and the maintenance of chronic pain. The hypothesis and the supporting data raise a couple of important issues: first, the neuroplasticity associated with chronic pain syndromes, and second, the type and the extent of plasticity affecting the cortex. These important and timely issues are well addressed by the authors. This article intends to broaden the discussion. The central nervous system probably has an important role in the development and maintenance of chronic pain in general. Specific aspects regarding pain syndromes and mechanisms underlying those pain syndromes are going to be addressed.