Social buffering in pain resilience and resolution

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Social and psychological factors are known to modulate pain processing via brain areas such as the prefrontal cortex, the anterior insula and the amygdala. However, so far there is little systematic evidence of whether and how the social environment affects resolution or persistence of clinically relevant pain syndromes and if so, which are the molecular mechanisms. To study these questions, we will investigate the impact of social factors in patients with two potentially reversible pain conditions, and in an animal model. These parallel approaches will allow us to specify the clinical importance of social factors for pain resilience and recovery, and the underlying molecular mechanisms. In the clinical part, we will focus on A) patients with bortezomib induced peripheral neuropathy (BIPN), with pain as the major symptom, which is the dose limiting complication in at least 30% of treated cancer patients, and B) patients with complex regional pain syndrome (CRPS) after a bone fracture of an extremity. In both conditions, resolution is prompt in many patients, but pain can be severe and long lasting in others. Factors determining resolution or persistence of the pain syndrome include alterations in peripheral and central nervous system responses, neuro-inflammation, as well as individual differences in psychological and social variables. This project aims to understand the effect of social factors on peripheral and molecular markers of pain resolution and pain chronification in a real-world context. To do so, we will use ecological momentary assessments (EMA) to characterize the social environment of patients that show prompt pain remission and those that suffer from chronic pain, and assess their relationship with peripheral pain markers. In parallel, we will test pain responses and remission in a social and non-social context in an animal model of BIPN. This animal work will specify the molecular processes through which social factors modulate pain, and thus provide novel insights into how social factors and pain interact on a molecular level.