Emotionally painful: insights in pain-related conditions with anomalies in emotion processing and regulation

Emotions and pain are inherent to human experience, and both are related. For example, it is known that the intensity of pain can be modified by the emotions experienced. Nevertheless, the relationship between emotions and pain is not fully understood. The aim of this thesis was to add knowledge on emotions and pain in the context of pain-related conditions with anomalies in emotion processing and regulation.
First, the prevalence rates of depression, anxiety and alexithymia in disorders with central sensitization and chronic pain were summarised. We found high prevalence rates for the three psychological conditions in such disorders. Next, we studied the neural correlates of emotion processing and regulation in fibromyalgia, a chronic widespread pain condition. We found that brain connectivity of regions previously related to pain modulation is affected during the processing and regulation of positive and negative emotional stimuli in fibromyalgia. Furthermore, alterations during resting state related to alexithymia were found. Finally, we studied the intrinsic brain connectivity of areas related to emotion regulation in borderline personality disorder, which is characterised by emotion dysregulation and alterations in pain processing. Our study focused on the interaction with cocaine dependence, a frequent comorbidity.
Overall, this thesis contributes to a better understanding of disorders characterised by pain and emotion processing and regulation difficulties, and points at future directions to improve the treatment of patients with such conditions. Additionally, it highlights the importance of acknowledging emotions when treating patients with pain conditions.