EXPRESS: Cortical mechanism of emotional pain

Most basic and clinical research on chronic pain has traditionally focused on the mechanisms and treatment of physical pain resulting from peripheral injuries in individual animals or humans. However, growing evidence highlights the importance of emotional pain, a form of distress that extends beyond the individual to include family members, partners, and friends affected by another's suffering. In this review, I summarize recent advances in animal models of empathic pain and explore cortical synaptic mechanisms underlying this form of social or emotional pain. I compare the cortical processes mediating physical pain and emotional pain, drawing on evidence from both human brain imaging and animal studies. Converging findings suggest that the anterior cingulate cortex (ACC) and insular cortex (IC) play central roles in the perception and persistence of emotional pain. Cortical potentiation appears to be a key synaptic mechanism driving long-term emotional pain, and cortical top-down modulation of spinal nociceptive transmission may help explain how emotional distress leads to abnormal somatosensory perception. Finally, the calcium-stimulated adenylyl cyclase subtype 1 (AC1) is discussed as a potential therapeutic target for the treatment of chronic pain and its associated emotional disorders.