Biobehavioral Interventions Targeting Learning-Related Alterations in Brain Circuits

We will present data on key brain changes  in primary somatosensory cortex, insula, anterior cingulate cortex, striatum and frontal cortex related to chronic pain based on our work on brain circuits involved in appetitive and aversive pavlovian conditioning, operant conditioning of pain reward and relief, spouse responding to pain and phantom limb pain. Specific interventions to target these brain changes involve behavioral interventions such as pain extinction retraining, its combination with cannabinoids, and the inclusion of neurofeedback and virtual and augmented reality based interventions. We show that an assignment of patients based on the key mechanism that is relevant for their type of pain boosts effect sizes and reduces drop out numbers. We also provide evidence that aberrant brain changes can be normalized by these targeted treatment approaches.