Dirk De Ridder, Sven Vanneste, Mark Smith, and Divya Adhia. Pain and the Triple Network Model. 2021. Frontiers in Neurology: Experimental Therapeutics. Epub 7 Mar 2022.
- Model to think about acute and chronic pain. Evidence provided by fMRI and connectivity data
- Acute pain = Somatic Pain “physical pain” as processed by the lateral pain network (S1)
- Limbic Pain “suffering/emotional experience” as processed by the medical pain network (Dorsal Anterior Cingulate Cortex)
- Pain Suppression by the Inhibitory pathway (Periaqueductal Gray Anterior Cingulate Cortex)
- Chronic pain = Loss of Pain Suppression by the Inhibitory Pathway
Triple Network:
- Default Mode Network (self-representation)
- Central Executive Network (goal-oriented behavior)
- Salience Network (behavior relevance): Determines if stimulus, based on the situation, is painful and requires intervention. Typically keeps the default mode network and central executive networks anticorrelated.
- In Acute Pain -> Salience Network down regulates Default Mode Network and up regulates Central Executive Network to address the painful stimulus
- In Chronic pain -> increased connectivity to the executive mode network resulting in a cognitive reaction, autonomic reaction, and emotional reaction.
- Presents as catastrophizing, attention paid to the pain, unpleasantness, fear, anger, frustration with pain, and arousal/distress. This presents as long-term suffering.
- If pain continuous: Significant energy cost to continuously upregulate Central Executive network in an attempt to address painful stimulus
- Brain incorporates painful stimulus (lateral and medial network activation) into Default Mode Network to save energy -> Embodiment
- Embodiment of the pain and suffering results in functional/social impact with increased disability, decreased sleep quality, and decreased quality of life. Much more difficult to treat.