Volumetric brain correlates of approach-avoidance behavior and their relation to chronic back pain

  • Frauke NeesEmail author
  • Michaela Ruttorf
  • Xaver Fuchs
  • Mariela Rance
  • Nicole Beyer
Original Research


Avoiding any harm, such as painful experiences, is an important ability for our physical and mental health. This avoidance behavior might be overactive under chronic pain, and the cortical and subcortical brain volumetry, which also often changes in chronic pain states, might be a significant correlate of this behavior. In the present study, we thus investigated the association between volumetric brain differences using 3 T structural magnetic resonance imaging and pain- versus pleasure-related approach-avoidance behavior using an Approach Avoidance Task in the laboratory in chronic back pain (N = 42; mean age: 51.34 years; 23 female) and healthy individuals (N = 43; mean age: 45.21 years; 15 female). We found significant differences in hippocampal, amygdala and accumbens volumes in patients compared to controls. The patients` hippocampal volume was significantly positively related to pain avoidance, the amygdala volume to positive approach, and the accumbens volume negatively to a bias to pain avoidance over positive approach. These associations were significantly moderated by pain symptom duration. Cortical structure may thus contribute to an overacting pain avoidance system in chronic back pain, and could, together with a reduction in approaching positive stimuli, be related to maladaptive choice and decision-making processes in chronic pain.


Approach Avoidance Brain volume Chronic pain Striatal-limbic 



This study was funded by the Deutsche Forschungsgemeinschaft (NE 1383/6–1 to F.N., SFB1158/B03 to F.N. and Herta Flor, and NE 1383/14–1).

Compliance with ethical standards

Conflict of interest

All authors declare no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Supplementary material

11682_2019_110_MOESM1_ESM.docx (966 kb)
ESM 1 (DOCX 965 kb)


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Frauke Nees
    • 1
    Email author
  • Michaela Ruttorf
    • 2
  • Xaver Fuchs
    • 1
  • Mariela Rance
    • 3
  • Nicole Beyer
    • 1
  1. 1.Department of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty MannheimHeidelberg UniversityMannheimGermany
  2. 2.Computer Assisted Clinical Medicine, Medical Faculty MannheimHeidelberg UniversityMannheimGermany
  3. 3.Department of Radiology and Biomedical ImagingYale UniversityNew HavenUSA

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