eprintid: 29471
rev_number: 13
eprint_status: archive
userid: 5771
dir: disk0/00/02/94/71
datestamp: 2021-03-17 14:24:49
lastmod: 2021-03-22 14:44:06
status_changed: 2021-03-17 14:24:49
type: doctoralThesis
metadata_visibility: show
creators_name: Usai, Katrin
title: Emotional learning and its impact on
back pain chronicity
subjects: ddc-570
divisions: i-140001
divisions: i-851200
adv_faculty: af-14
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.
date: 2021
id_scheme: DOI
id_number: 10.11588/heidok.00029471
ppn_swb: 1752065832
own_urn: urn:nbn:de:bsz:16-heidok-294713
date_accepted: 2021-02-22
advisor: HASH(0x561a6292a620)
language: eng
bibsort: USAIKATRINEMOTIONALL2021
full_text_status: public
place_of_pub: Heidelberg
citation:   Usai, Katrin  (2021) Emotional learning and its impact on back pain chronicity.  [Dissertation]     
document_url: https://archiv.ub.uni-heidelberg.de/volltextserver/29471/1/Dissertation_KatrinUsai_Feb2021.pdf