How control modulates pain

Abstract

Pain, an indicator of potential tissue damage, ideally falls under individual control. Although previous work shows a trend towards reduced pain in contexts where pain is controllable, there is a large variability across studies that is probably related to different aspects of control. We therefore outline a taxonomy of different aspects of control relevant to pain, sketch how control over pain can be integrated into a Bayesian pain model, and suggest changes in expectations and their precision as potential mechanisms. We also highlight confounding cognitive factors, particularly predictability, that emphasize the necessity for careful experimental designs. Finally, we describe the neurobiological underpinnings of how control affects pain processing in studies using different types of control, and highlight the roles of the anterior insula, middle frontal gyrus (MFG), and anterior cingulate cortex (ACC).

Keywords: agency; control; descending pain-modulatory system; helplessness; pain.