When it hurts even more: The neural dynamics of pain and interpersonal emotions

• Published in: Journal of psychosomatic research Vol. 128; p. 109881
• Main Authors: Landa, Alla, Fallon, Brian A., Wang, Zhishun, Duan, Yunsuo, Liu, Feng, Wager, Tor D., Ochsner, Kevin, Peterson, Bradley S.
• Format: Journal Article
• Language: English
• Published: England Elsevier Inc 01.01.2020; Elsevier Science Ltd
• Subjects: Adult; Anxiety; Caregivers; Centralization; Chronic pain; Chronic Pain - psychology; Circuits; Clinical medicine; Developmental; Early experience; Early interpersonal adversity; Emotions; Emotions - physiology; Etiology; Female; fMRI; Functional magnetic resonance imaging; Healthy Volunteers; Humans; Interpersonal emotion; Interpersonal Relations; Magnetic Resonance Imaging - adverse effects; Male; Middle Aged; Mood; Pain; Parent-child relations; Patients; Psychological distress; Psychosomatic medicine; Rejection; Social rejection; Thermal stimuli; Young Adult; Rejection; Developmental; fMRI; Pain; Interpersonal emotion; Early interpersonal adversity; Psychosomatic medicine
• ISSN: 0022-3999; 1879-1360; 1879-1360
• DOI: 10.1016/j.jpsychores.2019.109881

Chronic pain is highly prevalent among patients with mood, anxiety, personality, and somatic symptom disorders; and patients with chronic pain often suffer from persistent interpersonal distress. However, the neural mechanisms underlying this phenomenon and its possible role in the etiology of chronic pain are not yet understood. Based on our Developmental Theory of Centralized/Somatoform Pain, and prior research suggesting the existence of a shared neural system subserving interpersonal emotions and pain, we aimed to identify the neural basis for modulation of pain by feelings of interpersonal rejection and the role of the early interpersonal environment in development of this shared neural system. During fMRI scanning, 22 healthy participants received moderately painful thermal stimuli in 3 interpersonal contexts: Acceptance, Rejection, and Reacceptance (modified Cyberball paradigm). Early interpersonal environment was assessed using the Parental Bonding Instrument. Interpersonal context modulated activity in pain neural systems during rejection and during accepting interactions with previously rejecting others. Moreover, the subjective perception of rejection, even when rejection was not occurring, correlated positively with reported pain severity and neural activity in the insula. The magnitude of neural modulation in pain circuits by feelings of rejection was associated with the quality of early interpersonal experience with caregivers. Results suggest that interpersonal emotions play an important role in the development and functioning of the pain system, supporting our Developmental Theory of predisposition to chronic centralized pain. These findings have direct implications for clinical practice, including the importance of treating interpersonal distress to alleviate pain. •Feelings of interpersonal rejection modulate neural processing of pain.•Interaction with previously rejecting others affects neural response to pain.•Perceiving others as rejecting during accepting interactions amplifies pain on neural level.•Feelings of rejection may underlie loss of emotion vs pain neural differentiation.•Neural modulation of pain by interpersonal emotion is associated with quality of early parental care.