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Loeffer, Martin; Levin, Seth M.; Usai, Katrin; Desch, Simon; Kandic, Mina; Nees, Frauke and Flor, Herta (2022): Corticostriatal circuits in the transition to chronic back pain: The predictive role of reward learning. In: Cell Reports Medicine, Vol. 3, No. 7, 100677

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Abstract

Connectivity between the nucleus accumbens (NAc) and ventromedial prefrontal cortex (vmPFC) and reward learning independently predict the transition from acute to chronic back pain (CBP). However, how these pre-dictors are related remains unclear. Using functional magnetic resonance imaging, we investigate NAc-and vmPFC-dependent reward learning in 50 patients with subacute back pain (SABP) and follow them over 6 months. Additionally, we compare 29 patients with CBP and 29 pain-free controls to characterize mecha-nisms of reward learning in the chronic stage. We find that the learning-related updating of the value of rein-forcement (prediction error) in the NAc predicts the transition to chronicity. In CBP, compared with controls, vmPFC responses to this prediction error signal are decreased, but increased during a discriminative stim-ulus. Distinct processes of reward learning in the vmPFC and NAc characterize the development and main-tenance of CBP. These could be targeted for the prevention and treatment of chronic pain.

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