Brain-based interventions for chronic pain

Abstract Brain circuits involved in pain chronicity shift from areas involved in nociceptive processing to those associated with emotional and motivational processes. They overlap with circuits relevant for anxiety, fear and depression and are characterized by deficient prefrontal control mechanisms. Noninvasive brain stimulation techniques such as repetitive transcranial magnetic stimulation, transcranial direct and alternating current stimulation directly impact on these circuits and pain. Neurofeedback and brain-computer interfaces as well as various types of cognitive and behavioral interventions also alter these circuits. The analysis of brain changes related to pain chronicity helps to mechanistically tailor interventions to patient characteristics, can increase treatment efficacy and efficiency and can identify new treatment approaches.