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

Brain Imaging and Behavior volume 14, pages 1758–1768 (2020)Cite this article

Abstract

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.

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Funding

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).

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Authors and Affiliations

  1. Department of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, J5, 68159, Mannheim, Germany

    Frauke Nees, Xaver Fuchs & Nicole Beyer

  2. Computer Assisted Clinical Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany

    Michaela Ruttorf

  3. Department of Radiology and Biomedical Imaging, Yale University, New Haven, CT, USA

    Mariela Rance

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  1. Frauke Nees
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Correspondence to Frauke Nees.

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Nees, F., Ruttorf, M., Fuchs, X. et al. Volumetric brain correlates of approach-avoidance behavior and their relation to chronic back pain. Brain Imaging and Behavior 14, 1758–1768 (2020). https://doi.org/10.1007/s11682-019-00110-x

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Keywords

  • Approach
  • Avoidance
  • Brain volume
  • Chronic pain
  • Striatal-limbic