A mechanism-based approach to chronic pain

The transition of acute to chronic pain is characterized by a shift from nociceptive brain circuits to those involved in emotion, motivation, cognition and learning. Psychological and neurobiological determinants of these evolving circuits are discussed and it is suggested that different concepts of chronicity may have a common psychobiological basis. Treatments must target these shifts in brain circuits and must be tailored to the specific mechanisms. Novel treatments focus on the modification of central changes via ecological momentary interventions, neurofeedback and behavioral extinction retraining. Virtual reality applications, neurostimulation approaches and combinations with pharmacological enhancers of plasticity may also be useful.