Chronic back pain (CBP) is a leading cause of disability and results in considerable socio-economic burdens worldwide. Although CBP patients are commonly diagnosed and treated with a focus on the ‘end organ dysfunction’ (i.e., peripheral nerve injuries or diseases), the evaluation of CBP remains flawed and problematic with great challenges. Given that the peripheral nerve injuries or diseases are insufficient to define the etiology of CBP in some cases, the evaluation of alterations in the central nervous system becomes particularly necessary (...) and important. With the development of advanced neuroimaging techniques, extensive studies have been carried out to identify the cortical abnormalities in CBP patients. Here, we provide a comprehensive overview on a series of novel findings from these neuroimaging studies to improve our understanding of the cortical abnormalities originated in the disease. First, CBP patients normally exhibit central sensitization to external painful stimuli, which is indexed by increased pain sensitivity and brain activations in pain-related brain regions. Second, long-term suffering from chronic pain leads to emotional disorders, cognitive impairments, and the abnormalities of the relevant brain networks among CBP patients. Third, CBP is associated with massive cortical reorganization, including structural, functional, and metabolic brain changes. Overall, a deep insight into the neural mechanisms underlying the development and outcome of CBP through more sophisticated neuroimaging investigations could not only improve our current understanding of the etiology of CBP but also facilitate the diagnosis and treatment of CBP based on precision medicine. (shrink)

In my thesis, I challenge existing philosophical and scientific accounts of pain to explain certain constitutional, functional and empirical problems. Though difficult, some of these problems will be familiar. Unlike perceptual experiences, pains are strikingly affective and when we are in pain we are primarily concerned with the experience itself rather than mind-independent objects. The obvious explanation, that pain is not a perceptual experience, would be appealing if it were not for the fact that pains vary in quality, intensity and (...) location. These seem to be features of paradigmatic perceptual experiences. The magnitude of another problem, the weakness of the correlation between pain and the stimulus, has been under-played. It is widely observed that those with chronic conditions experience pain in the absence of the stimulus and in circumstances like sport and war severe injuries occur in the absence of pain. I argue that the variable relationship between pain and the stimulus is normal; it is not confined to abnormal cases or circumstances. As no existing account proves explanatorily adequate, I develop a novel position called ‘near-motivationalism’ from a revisionary approach to the conceptual models of pain science. This has the power to solve the problems I set. (shrink)