Perceptual Inference in Chronic Pain

Tabor, Abby; O’Daly, Owen; Gregory, Robert W.; C, Jacobs; Travers, Warren; Thacker, Michael; Moseley, G. Lorimer

doi:10.1097/ajp.0000000000000305

Cited by 16 publications

(8 citation statements)

References 36 publications

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“…Modern pain science requires us to conceptualize pain as an "output" of our biological substrate, most conveniently described as an output of the brain 30,31 (although see Thacker and Moseley 32 for important traps associated with that convenience). Pain can be conceived as a perceptual inference 33 rather than a message that is generated at the tissues and transmitted to the brain. 34 As such, pain is most obviously about protection of the physical self rather than a perceptual marker of the state of the body tissues.…”

Section: Pain Movement and Protectionmentioning

confidence: 99%

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Applying Current Concepts in Pain-Related Brain Science to Dance Rehabilitation

2017

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Dance involves exemplary sensory-motor control, which is subserved by sophisticated neural processing at the spinal cord and brain level. Such neural processing is altered in the presence of nociception and pain, and the adaptations within the central nervous system that are known to occur with persistent nociception or pain have clear implications for movement and, indeed, risk of further injury. Recent rapid advances in our understanding of the brain's representation of the body and the role of cortical representations, or "neurotags," in bodily protection and regulation have given rise to new strategies that are gaining traction in sports medicine. Those strategies are built on the principles that govern the operation of neurotags and focus on minimizing the impact of pain, injury, and immobilization on movement control and optimal performance. Here we apply empirical evidence from the chronic pain clinical neurosciences to introduce new opportunities for rehabilitation after dance injury.

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Section: Pain Movement and Protectionmentioning

confidence: 99%

“…If these "protective neurotags" are sufficiently influential, then the motor output is affected and the performance is compromised. That is, the final movement reflects a "best guess" 33 on what is an optimal response under the competing demands of performance and protection (Fig. 1).…”

Section: Theoretical Models: the Cortical Body Matrix Action And Modu...mentioning

confidence: 99%

Applying Current Concepts in Pain-Related Brain Science to Dance Rehabilitation

2017

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“…Unexpected pain is likely to amplify multisensory perceptual inference serving to protect the integrity of tissue by creating, for example, fear-avoidance of movement (i.e., the motivational-decision model of pain [80]). Individuals experiencing pain over-estimate the distance and the effort needed to walk to a target [81] and perceive targets to be further away [82] (i.e., economy of action hypothesis), although potential scaling of spatial perceptions during pain have not been consistently demonstrated [83]. Actions that fail to restore coherence of behavior may also contribute to perceptual dysfunctions accompanying pain.…”

Section: Pain Perception: Active Top-down Processing?mentioning

confidence: 99%

The Landscape of Chronic Pain: Broader Perspectives

Johnson

2019

Medicina

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Chronic pain is a global health concern. This special issue on matters related to chronic pain aims to draw on research and scholarly discourse from an eclectic mix of areas and perspectives. The purpose of this non-systematic topical review is to précis an assortment of contemporary topics related to chronic pain and its management to nurture debate about research, practice and health care policy. The review discusses the phenomenon of pain, the struggle that patients have trying to legitimize their pain to others, the utility of the acute–chronic dichotomy, and the burden of chronic pain on society. The review describes the introduction of chronic primary pain in the World Health Organization’s International Classification of Disease, 11th Revision and discusses the importance of biopsychosocial approaches to manage pain, the consequences of overprescribing and shifts in service delivery in primary care settings. The second half of the review explores pain perception as a multisensory perceptual inference discussing how contexts, predictions and expectations contribute to the malleability of somatosensations including pain, and how this knowledge can inform the development of therapies and strategies to alleviate pain. Finally, the review explores chronic pain through an evolutionary lens by comparing modern urban lifestyles with genetic heritage that encodes physiology adapted to live in the Paleolithic era. I speculate that modern urban lifestyles may be painogenic in nature, worsening chronic pain in individuals and burdening society at the population level.

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“…The current understanding of pain suggests that it is an emergent protective output in response to an implicit evaluation of danger (Moseley, 2007 ; Tabor et al, 2016 ; Moseley and Butler, 2017 ), aimed at minimizing the real or perceived risk of further pain or damage (van Dieen et al, 2017 ). Thus, it is entirely possible that the observed motor behavior may reflect a helpful, top-down adaptive strategy when faced with a high-load task such as jumping; potentially perceived as threatening when one has a sore back.…”

Section: How Should Pain-related Differences In Motor Behavior Be Intmentioning

confidence: 99%