Nature Outlook |

Pain

Nature Outlook: Pain examines new ways to treat chronic and neuropathic pain. It provides high-quality coverage on pain research, including a timeline showing how treatments have evolved from the Ancient Egyptians to now. You can also dive into an infographic that outlines normal, healthy pain mechanisms, allowing you to gain an understanding of how these change to disease states of chronic and neuropathic pain.

This Outlook is available free online for six months and provides clear, concise articles on pain research. It tackles the hottest areas of scientific, clinical and societal research, giving you an inside view of the latest developments within the field of pain.

For more on pain from nature.com, see: nature.com/subjects/pain

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Content

We can't live without it, but many of us struggle to live with it. Pain has an essential biological function, but too much — or the wrong sort — ruins lives and puts a sizeable dent in economic productivity. By David Holmes, infographic by Mohamed Ashour.

Outlook | | Nature

The dearth of treatment options for chronic pain has led to widespread over-prescription of strong opioids. But some innovative thinking is building a promising pipeline.

Outlook | | Nature

Technology for peering into the brain is revealing a pattern of pain, and differences between the acute and chronic forms.

Outlook | | Nature

People with neuropathic pain have struggled to find relief with conventional drugs. Researchers are investigating whether more meaningful pain classifications could help.

Outlook | | Nature

Although genetics studies have so far failed to revolutionize pain treatments, some researchers think that a host of discoveries are just around the corner.

Outlook | | Nature

Armed with a clearer understanding of how placebos work, researchers are suggesting that inactive substances might be used to mitigate chronic pain.

Outlook | | Nature

The 'war on drugs' has left many in developing nations with no access to strong painkillers. But governments in these countries are learning to stop worrying and love the poppy.

Outlook | | Nature

For thousands of years people have sought explanations for pain and ways to ease it. Despite a better understanding of the mechanisms behind the sensation, much remains baffling, and the search for better treatments continues. By Stephanie Pain

Outlook | | Nature

Related articles

In a longitudinal brain imaging study, patients with subacute back pain were followed over the course of 1 year. Initially greater functional connectivity of nucleus accumbens with prefrontal cortex predicted pain persistence, implying that corticostriatal circuitry is causally involved in the transition from acute to chronic pain.

Brief Communication | | Nature Neuroscience

Anterior insula (AI) and medial anterior cingulate cortex (mACC) are activated by self and vicarious pain, disgust and fairness, yet the overlap of these representations are not known. Here the authors provide evidence for shared neural codes in the left AI and mACC and distinct codes in the right AI.

Article | Open Access | | Nature Communications

The desire to avoid withdrawal symptoms is a major driver of continued drug use in opiate addicts, but the neural circuitry that mediates withdrawal symptoms is not well understood. Xiaoke Chen and colleagues show that a pathway from the paraventricular nucleus of the thalamus (PVT) to the nucleus accumbens (NAc) mediates behavioural aversion, including opiate withdrawal symptoms, through potentiation of synaptic transmission between PVT neurons and dopamine 2 (D2)-receptor-expressing medium spiny neurons. Optogenetic silencing of this pathway abolishes opiate withdrawal symptoms and suppresses behavioural aversion in response to stressful stimuli, pointing to a generic role in controlling the response to negative experiences.

Letter | | Nature

Chronic pain is a common problem that incurs substantial costs to the individual and society as a whole. The efficacy of currently available medications is limited, prompting the exploration of alternative therapeutic approaches. Here, Jensen et al. summarize the state of knowledge regarding the efficacy and mechanisms of four different neuromodulatory interventions—hypnosis, meditation training, noninvasive brain stimulation, and neurofeedback—for the treatment of chronic pain.

Review Article | | Nature Reviews Neurology

The medial prefrontal cortex (mPFC) is implicated in pain regulation, yet the underlying mechanisms are poorly understood. Here the authors establish a critical role for mPFC in regulating pain sensation and pain-related anxiety, mediated by activation of the cyclin-dependent kinase 5 signalling pathway.

Article | Open Access | | Nature Communications