Psychology, psychiatry, and brain neuroscience in pain medicine: new tools for a new science.

The seminal roles of cognitive, emotional, and social processes in shaping the experience of pain have been appreciated, at least to some degree, for a very long time.However, it is only in the relatively recent past that tools such as functional neuroimaging have permitted investigation of the interface between such factors and the neurobiology of pain processing. As one example, consider the case of placebo effects in pain research [1,2]. It has long been recognized that the perception of pain is not dictated solely by noxious input, and that administration of inert “treatments” could have powerful analgesic effects in certain individuals, under particular conditions, though the mechanisms underlying these effects remained mysterious. Thanks to multidisciplinary research in a number of laboratories around the world, we now understand that cognitive expectations for pain relief are involved in generating endogenous opioid-mediated placebo analgesic responses within areas of the prefrontal cortex, and such cognitive processes have been shown to decrease pain intensity and cerebral responses to pain in regions of the pain neuromatrix such as the anterior cingulate cortex, insula, and thalamus [3]. Intriguingly, placebo analgesia at the level of spinal pain processing has recently been demonstrated, making it clear that cognitive and affective processes can exert a cascading impact on pain processing throughout the nervous system [4]. This new section of Pain Medicine explores the intersection between psychology, psychiatry, and neuroscience in pain research. Our hope is that this section will produce a broad spectrum of publications, ranging from, for example, functional or structural neuroimaging studies of factors that influence central pain processing, to epidemiologic investigations of psychiatric disorders in patients with chronic pain, to evaluations of genetic contributions to individual differences in pain responses, and to studies of psychological predictors of responses to pain treatment. As Section Co-editors, we hope to encourage rigorous, creative scientific manuscripts representing attempts to advance our understanding and characterization of the biopsychosocial model of pain. To assist us in developing this Section, we have recruited a number of Associate Editors with diverse backgroundswho possess abundant experience and a broad array of interests and expertise; their assistance and advice will be invaluable in the development of this new section of Pain Medicine. Many readers will be familiar with exciting, recent publications within this arena of pain research (and many may also be involved in conducting such work). Some relevant findings within the past several years include: interactions between negative affective processes (i.e., catastrophizing about pain) and genotype shape individual differences in pain treatment outcomes [5]; early life personality disorders confer increases in long-term risk for the development of pain conditions [6]; individual differences in levels of distress are crucially important in determining the degree of analgesia provided by opioids, and the likelihood of abusing opioid medications [7]; documentation of the neural basis for empathic reactions to pain in others [8]; and illustration of the disruptive effects of chronic pain and depression on the functional connectivity of the brain [9]. This all-too-brief list is meant only to give a flavor for the breadth of studies that would come under the purview of this section. Our goal in launching this new section is to consolidate some of these important findings within the pages of Pain Medicine, a multidisciplinary journal with a broad readership, dedicated to the pain clinician, teacher and researcher. As this journal is devoted to the advancement of painmanagement, education, and research, we hope that many readers will consider this Section and this journal as an outlet for their work. As Co-editors dedicated to the success of this Section, we will assure expeditious, expert reviews of your submitted manuscripts, and timely publication of accepted articles.We would be delighted to discuss potential manuscripts with any interested authors; please do not hesitate to contact either of us by phone or e-mail with any questions or suggestions. PAIN MEDICINE Volume 9 • Number 8 • 2008