An altered brain system evolves with new connections, changes in grey matter volume to produce a ‘lighter iceberg’ where now more is obvious above the waterline (i.e., overt behavior), while ongoing dysregulation may be ongoing. The behavior becomes overt (and usually progressively worse) at a particular time. State III: Overt Pain Behavior (Right): A number of changes in brain systems including morphometric, chemical and functional metrics that lead to a brain state of chronic pain (Pain Connectome Definition). These may be categorized as: (a) Network malfunction (b) Network Disarray (c) Pain Connectome Development and (d) Pain Connectome Formation. Multiple processes may be at play following a perturbation that may be endogenous (e.g., depression) or exogenous (e.g., trauma). State II: Subliminal “Pain” (Middle): A pain event (viz., injury, a disease, a genetic condition, etc.) produces a transition fromm State I to State II. Under healthy conditions, the tip of the iceberg presents with an adaptive behavior based on underlying normal brain network interactions that may be dependent on environment, health status, genetic status, etc. The Iceberg Principle and Chronic Pain (see Text). In this paper we refer to a number of terms that may require defining in the context of how they are applied here are shown in Box 1. The Iceberg Principle has been defined as: “ Observation that in many (if not most) cases only a very small amount (the ‘tip’) of information is available or visible about a situation or phenomenon, whereas the ‘real’ information or bulk of data is either unavailable or hidden” ( The expression of pain may follow this principle in a number of ways (see Fig. The so called ‘ Iceberg Principle’ provides an example of conscious (above water) and non-conscious (underwater) contributions to the overall ongoing process that may change with time. Clearly non-conscious processes may be ongoing. The transition from acute to chronic pain is one example of how brain systems may change to incorporate initial drivers of acute pain that may contribute to the complexities of brain changes that manifest in chronic pain. Modulation of brain systems may result in changes in behavior. research on subliminal perception, implicit memory and hypnosis indicates that events can affect mental functions” even though they are not part of our conscious awareness ( Kihlstrom, 1987). Taken together, such processes are reflective of “ The Cognitive Unconscious” wherein “…. In addition, there is unconscious processing of negative emotions ( Okubo and Ogawa, 2013). Unconscious perception – processing of sensory information that we are not aware of – has been evaluated in other systems including visual ( Brogaard, 2011 Kiefer et al., 2011) and motor ( Morsella and Poehlman, 2013). Examples include: (1) Experimental manipulation of subconsciousness can affect nociceptive processing ( Lewis et al., 2015) (2) unconscious manipulation of the placebo or nocebo responses ( Jensen et al., 2012a) (3) decreased pain perception modulated by unconscious emotional pictures ( Pelaez et al., 2016) and (4) classical conditioning of pain without awareness of conditioning cues ( Jensen et al., 2015). In the context of experimental pain, elements of subconscious processing have been reported in healthy subjects. Subliminal processes may contribute to overt behavior as they do in unconscious processes in the control of actions ( Morsella and Poehlman, 2013). Several systems have been considered to play a role in the latter including perceptual, evaluative and motivational components ( Bargh and Morsella, 2008). Such processes may eventually have an effect on an individual’s awareness ( Kihlstrom, 1987). Unconscious neural processing involves neural connections that may be unperceived by the individual ( Zeman, 2001). Conscious “inner qualitative, subjective states and processes of awareness” ( Searle, 2000) is a complex neurobiological process ( Delacour, 1997). Subtle ongoing conscious or subconscious processes contribute to a brain state that defines the ‘chronic pain phenotype’, usually associated with a complex phenotype involving sensory, emotional, cognitive, endocrine and other processes. The emergence of chronic pain is usually not abrupt in onset.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |