The default mode of chronic pain: What does it mean and how should we frame it to our patients?

Abstract

The brain can be organised into defined networks based on the coherent activity fluctuations between certain regions at rest when no external task or stimuli are applied. In patients with chronic pain, alterations in the way these networks act and interact become apparent, especially within the default mode network (DMN) and in the way it functionally interacts with the salience network (SN). However, the implications of these cortical alterations remain speculative, and a clear framework for how we might explain the meaning of them to the patient with chronic pain is lacking. Therefore, here we provide an up-to-date theoretical model for the implications of the DMN alterations observed in the state of chronic pain, and to integrate the key points of this model into an explanatory framework to use in the clinical meeting with chronic pain patients (e.g., during pain neuroscience education).