Directly to content
  1. Publishing |
  2. Search |
  3. Browse |
  4. Recent items rss |
  5. Open Access |
  6. Jur. Issues |
  7. DeutschClear Cookie - decide language by browser settings

Emotional learning and its impact on back pain chronicity

Usai, Katrin

[thumbnail of Dissertation_KatrinUsai_Feb2021.pdf]
Preview
PDF, English
Download (20MB) | Terms of use

Citation of documents: Please do not cite the URL that is displayed in your browser location input, instead use the DOI, URN or the persistent URL below, as we can guarantee their long-time accessibility.

Abstract

Chronic back pain is a worldwide health issue. Patients suffering from chronic pain often live in a vicious cycle of disability and distress. Neuroimaging studies have already shown that the brain changes in its structure and function once the pain has become chronic. However, it is not well understood, whether these changes are also predictors of pain chronicity and which are the relevant underlying mechanisms in this process. Emotional learning may play an important role in this context. The investigation of functional and structural changes in the brain concomitant with associated emotional learning mechanisms might help to identify risk and resilience factors in the transition from acute to chronic back pain. The aim of this thesis is to investigate appetitive and aversive learning mechanisms in patients with subacute back pain and chronic back pain, compared to a group of healthy controls, using functional magnetic resonance imaging. Emotional learning-related brain mechanisms seemed to be maladaptive in patients with back pain affecting the subacute and chronic back pain stage differently. This was indicated by a weaker activation of the hippocampus and the amygdala, but stronger activation in the parietal operculum during appetitive learning in subacute pain patients when compared to healthy controls. Chronic back pain patients showed weaker activations in the nucleus accumbens and the hippocampus besides stronger activation seen in the posterior cingulate cortex in comparison to the healthy control sample. Both pain samples showed a shift away from reward-related brain regions towards pain-related brain areas during appetitive learning. Subacute and chronic back pain patients revealed enhanced aversive learning responses in comparison to healthy controls with a strong impact of the limbic system on learning-related brain activation. Moreover, emotional learning responses in subacute back pain patients seemed to be driven by responses to affective sensory stimulation in the orbitofrontal cortex. A brain region which is thought to process reward-related information, such as the orbitofrontal cortex, influenced learning in the early subacute pain stage, irrespective of the tested learning mechanism. These findings suggest that emotional learning might be an important mechanism causing the transition from acute to chronic pain, indicated by neuroplastic changes in the brain that may serve as predictive markers of pain chronicity.

Document type: Dissertation
Supervisor: Spanagel, Prof. Dr. Rainer
Place of Publication: Heidelberg
Date of thesis defense: 22 February 2021
Date Deposited: 17 Mar 2021 14:24
Date: 2021
Faculties / Institutes: The Faculty of Bio Sciences > Dean's Office of the Faculty of Bio Sciences
Service facilities > Zentralinstitut für Seelische Gesundheit
DDC-classification: 570 Life sciences
About | FAQ | Contact | Imprint |
OA-LogoDINI certificate 2013Logo der Open-Archives-Initiative