The Brain or the Body: What Is the Target for Pain Treatment

Historically, pain has been viewed as a symptom of perturbations in the tissues of the body, such that effective treatments would address the damage to the affected body region and pain relief would ensue. However, both clinical experience and the scientific literature are replete with examples of such body based treatments failing to relieve pain. In recent years, accumulating evidence implicates changes in the structure and function of the brain as important contributors to the pathophysiology of chronic pain, with some thought leaders concluding that chronic pain is often a brain disease in its own right. This raises the question whether the brain or the body represents the best target for pain treatment. This course will present a conceptual model of chronic pain based on a continuum of peripheral vs central contributions. Examples of pain conditions and their location on the continuum will be provided, and assessment methods that can be used to determine where a given patient falls on the spectrum will be discussed. Then, an overview of treatment approaches whose mechanisms cover the spectrum from peripheral to central pain mechanisms will be provided, including pharmacological, behavioral/psychological, and neuromodulatory therapies. The session will conclude with a discussion of how to decide whether treatment for a given patient should target the brain or the body and how best to tailor treatment to the mechanisms underlying that patient's pain condition. (Recorded at PAINWeek 2016)