Neuroscience of Pain, Stress, and Emotion: Psychological and Clinical Implications

Book Preface

In the course of my 35 years as a pain researcher and clinician I have hadthe opportunity to attend numerous international scientific meetings that featured plenary talks in which the biopsychosocial model of pain was discussed. Though many of the presenters were well known and their talks well organized, all too often I have left these sessions with a feeling of disappointment. For example, a prominent psychologist might give an overview of the biopsychosocial model and then spend most of his or her time talking about studies of the psychology of pain. Likewise, a worldrenowned basic scientist giving a plenary talk might briefly mention the biopsychosocial model, but then focus his or her talk on novel basic science findings on the biology of pain with little attempt to relate these findings to psychological or social aspects of pain.

One of the hallmarks of the biopsychosocial model is its insistence that pain (and other phenomena such as stress) is best understood when biological, psychological, and social viewpoints are integrated. This book exemplifies this approach as few others have. It is written by two international experts whose own research programs on pain and stress represent a gold standard against which others are compared. The systematic and programmatic nature of their work is impressive, with one study building logically upon another. Dr Magne Flaten, for example, has conducted a series of important studies on the role of expectations (placebo, nocebo) in pain and pain regulation. Dr Mustafa al’Absi is widely recognized for his program of neurobiological research linking pain to stress, appetite, and addiction.

In this book, Drs Flaten and al’Absi have assembled a set of well-written chapters provided by authors, each of whom is a world-class expert in his or her field. Each chapter provides an up-to-date overview of a key topic in the pain and stress area. Readers will find many of the chapters to be true gems. To mention a few of these: Robert Mursin provides a superb overview of the neurobiology of stress. A key message is the importance that early learning and social status have in the development of stress and pain-regulation processes. A chapter by Jamie Rhudy critically appraises recent studies of pain and emotion and highlights emerging findings that suggest that problems with emotional modulation may be a risk factor for persistent pain. Drs Flaten and al’Absi’s own chapter on pain and placebo is one of the best in this book because it brings together state-of-the-art studies dealing with biological processes (endogenous opioids) and psychological processes (instructions, expectations) that are critical to our current understanding of placebo effects on pain. This chapter is nicely complemented by a chapter by Drs Amanzio, Plaermo, and Benedetti on nocebo and pain. This research team is internationally recognized for the development of novel methodologies for studying both placebo and nocebo processes and linking these responses to underlying biochemical and anatomical findings. Finally, Blaine Ditto and his colleagues provide an excellent overview of studies of pain, blood pressure, and hypertension. This chapter is one of the best I’ve seen on this topic since it includes novel insights into how blood pressure-related hypoalgesia can modulate both pain and stress.

Clinicians working in the areas of pain and stress will find this book extremely helpful because it provides research that will help them understand clinical phenomena they deal with every day. For a clinician, understanding the biological processes by which stress influences pain, or the neurobiology of stress and addiction in patients suffering from chronic pain, is important for several reasons. First, it enables the practitioner to better understand the varied ways that different individuals cope with persistent pain or stress. Second, it provides information that can be used to educate patients in ways that help them reconceptualize pain and stress and better understand what they can do to manage problematic responses. Finally, understanding the current literature on pain and stress can help clinicians better tailor their interventions so as to best address a given patient’s concerns.

Researchers interested in pain and stress will find this book to be invaluable. Each chapter highlights important emerging areas of research and pinpoints key directions for future research. Those looking to develop their own research agenda and program of research will want this book in their personal library.

If you are looking for a book that truly integrates the biological, psychological, and social perspectives on pain and stress I encourage you to get this book. Readers eager to learn about the latest research linking the different elements of the biopsychosocial model (biological to psychological, psychological to social, biological to social) will enjoy this book immensely. The book exemplifies the best of the biopsychosocial model and demonstrates how the promise of this model is now being fulfilled. If you’ve been disappointed by prior plenary talks, review papers, and chapters on the biopsychosocial model of pain and stress I encourage you to give this book a read. This book will not disappoint you. Instead, it will enlighten, energize, and excite you.

Francis J. Keefe, PhD
Professor, Psychiatry and Behavioral Sciences, Duke Medical Center
Professor of Psychology and Neuroscience, Duke University