Dr. William Yvorchuk, MD
Department of Psychiatry
University of Florida
“Dr Yvorchuk has disclosed that he has no relevant financial relationship(s). No one else in a position to control content has any financial relationships to disclose.”
Conflict of interest information for the CME Advisory Committee members can be found on the following website: https://cme.ufl.edu/disclosure/. All relevant financial relationships have been mitigated.
Release Date: July 21, 2022
Expiration Date: July 20, 2025
Target Audience: All physicians
As a result of participation in this activity, participants should be able to:
- Determine the difference in emotional component of acute vs chronic pain.
- Define the differential pattern of connectivity of the NAC core and shell regions.
- Define the change in NAC connectivity with the chronification of pain.
- Determine that the chronification of pain arises through the limbic system and the addiction pathway.
- Determine that chronic pain has a primary emotional foundation.
Requirements for successful completion: Certificates are awarded upon successful completion (80% proficiency) of the post-test.
Accreditation: The University of Florida College of Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
Credit: The University of Florida College of Medicine designates this enduring material for a maximum of _1_ AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Resource(s) for further study:
- Apkarian, AV. Pain perception in relation to emotional learning. Curr Opin Neurobiol. 2008 August; 18(4): 464-468. Doi:10.1016/j.conb.2008.09.012
- Cervero F, Laird JM (1996). Mechanisms of touch-evoked pain (allodynia): a new model. Pain 68:13-23.
- Apkarian, AV et al. Human brain mechanisms of pain perception and regulation in health and disease. European Journal of Pain 9 (2005) 463-484.
- Tracey I. Imaging Pain. British Journal of Anaesthesia 101 (1): 32-9 (2008); doi: 10.1093/bia/aen102.
- Baliki MN, et al. Chronic Pain and the Emotional Brain: Specific Brain Activity Associated with Spontaneous Fluctuations of Intensity of Chronic Back Pain. The Journal of Neuroscience, November 22, 2006. 26(47):12165-12173.
- Baliki MN, et al. Corticostriatal functional connectivity predicts transition to chronic back pain. Nature Neuroscience Volume: 15, 2012, pp1117-1119; doi:10.1038/nn.3153.
- Mansour AR, Baliki MN, Huang L, Torbey S, Herrmann KM, Schnitzer TJ, & Apkarian A. (2013). Brain white matter structural properties predict transition to chronic pain. Pain, 154(10), 2160-2168. https://pubmed.ncbi.nlm.nih.gov/24040975/
- Hashmi JA, Apkarian AV, et al. Shape shifting pain: chronification of back pain shifts brain representation from nociceptive to emotional circuits. Brain 2013: 136; 2751-2768; doi:10.1093/brain/awt211.
- Mutso AA, Baliki MN, Apkarian AV, et al. Reorganization of hippocampal functional connectivity with transition to chronic back pain. J Neurophysiol 111: 1065-1076, 2014. Doi:10.1152/jn.00611.2013.
- Baliki M, Apkarian AV, et al. Parceling Human Accumbens into Putative Core and Shell dissociates encoding values for reward and pain. The Journal of Neuroscience, October 9, 2013. 33(41):16383-16393.
- Baliki M, Apkarian AV, et al. Predicting Value of Pain and Analgesia: NAC Response to Noxious Stimuli Changes in the Presence of Chronic Pain. Neuron 66, 04.15.2010: 149-160.
- Lorenz J, et al. Keeping pain out of mind: the role of the dorsolateral prefrontal cortex in pain modulation. Brain (2003), 126, 1079-1091.
- Apkarian AV, et al. Chronic Back Pain is Associated with Decreased Prefrontal and Thalamic Gray Matter Density. The Journal of Neuroscience, November 17, 2004. 24(46):10410-10415.
- Apkarian AV, Baliki MN, Farmer MA: Predicting transition to chronic pain. Curr Opin Neurol. 2013 August; 26(4): 360-367. Doi:10.1097/WCO.0b013e32836336ad.
- Vachon-Presseau E, Apkarian AV, et al. The Emotional Brain as a Predictor and Amplifier of Chronic Pain. Journal of Dental Research 2016, Vol. 95(6) 605-612.
- Rabiner EA et al. Molecular and functional neuroimaging of human opioid receptor pharmacology. Molecular Psychiatry (2011) 16, 785.
- Parks EL, et al. Brain activity for chronic knee osteoarthritis: Dissociating evoked pain from spontaneous pain. Fur J Pain. 2011 Sep;15(8):843.e1-14. Doi:10.1016/j.ejpain.2010.12.007.
- Apkarian AV, et al. Towards a Theory of Chronic Pain. Prog Neurobiol 2009 February; 87(2):81-97. Doi:10.1016/j.pneurobio.2008.09.018.
- Grant JA, et al. Cortical Thickness and Pain Sensitivity in Zen Meditators. Emotion 2010, Vol. 10, No. 1, 43-53.
- Zeidan et al. Brain Mechanisms Supporting Modulation of Pain by Mindfulness Meditation. J Neurosci. 2011 April 6; 31(14): 5540-5548. Doi:10.1523/JNEUROSCI.5791-10.2011.
- Lazar et al. Meditation experience is associated with increased cortical thickness. Neuroreport. 2005 November 28; 16(17): 1893-1897.
- Holzel BK, et al. Stress reduction correlates with structural changes in the amygdala, SCAN (2010) 5, 11-17.
- Holzel BK, et al. Mindfulness practice leads to increases in regional brain gray matter density, Psychiatry Research: Neuroimaging 191 (2011) 36-43.
- Brischoux F, et al. Phasic excitation of dopamine neurons in ventral VTA by noxious stimuli, Proc Nat Acad Sci USA, March 24, 2009; 106(12) 4894-4899; www.pnas.org/cgi/doi/10.1073/pnas.0811507106
- Ball D (2007). Addiction science and its genetics. Addiction 103 (3): 360-7.
- Everitt BJ, Robbins TW (2005). Neural systems of reinforcement for drug addiction: from actions to habits to compulsion. Nature Neu 8(11):1481-1489.
- Hyman SE (2005) Addiction: a disease of learning and memory. American Journal of Psychiatry 162(8): 1414-1422.
- Hyman SE, Malenka RC, Nestler EJ. Neural mechanisms of addiction: the role of reward-related learning and memory. Annual Review of Neuroscience (2006) 29:565-98.
- Gass JT, Olive MF (2008). Glutamatergic substrates of drug addiction and alcoholism. Biochemical Pharmacology 75(1): 218-265.
- Kalivas PW, Volkow ND. The Neural Basis of Addiction-Pathology of Motivation and Choice. American Journal of Psychiatry (2005) 162:8, 1403-13.
- McCauley K. Pleasure Unwoven, (Video)
- Kalivas PW, Volkow ND, Seamans J (2005). Unmanageable motivation is addiction: a pathology in prefrontal-accumbens glutamate transmission. Neuron 45: 647-650.
- Kringelbach ML (2005). The Human orbitofrontal cortex linking reward to hedonic experience. Nature Reviews Neuroscience 6(9): 691-702.
- LeMoal M, Koob GF. Drug addiction: pathways to the disease and pathophysiological perspectives. European Neuropsychopharmacology (2007) 17: 377-93.
- Mayfield RD, Harris RA, Schuckit MA. Genetic factors influencing alcohol dependence. British Journal of Pharmacology (2008) 1-13.
- Morgan D, et al. Social dominance in monkeys – dopamine D2 receptors and cocaine self-administration. Nature Neuroscience (2002) 5(2): 169-174.
- Robinson TE, Berridge KC. Addiction. Annual Review of Psychology (2003) 54:24-53.
- Craig AD. Pain Mechanisms: Labeled Lines Versus Convergence in Central Processing. Annual Review of Neuroscience Vol. 26: 1-30 (March 2003); doi:10.1146/annurev.neuro.26.041002.131022.
- Stillman M. Clinical approach to patients with neuropathic pain. Cleveland Clinic Journal of Medicine Vol. 73 No. 8, August 2006, pp 726-739.
- Ossipov MH, et al. Central modulation of pain. J Clin Invest. 2010;120(11):3779-3787. Doi:10.1172/JCI43766.
- Raichle ME. A Paradigm Shift in Functional Brain Imaging, Journal of Neuroscience, October 14, 2009. 29(41):12729-12734.
- Apkarian AV, Hashmi JA, Baliki MW. Pain and the brain: Specificity and plasticity of the brain in clinical chronic pain. Pain 152 (2011) S49-S64.
- Hikida T, et al. Pathway-specific modulation of nucleus accumbens in reward and aversive behavior via selective transmitter receptors, Proc Nat Acad Sci USA, Jan 2, 2013; 110(1): 342-347; www.pnas.org/cgi/doi/10.1073/pnas.1220358110.
- Krack P, et al. Deep brain stimulation: from neurology to psychiatry? Trends in Neurosciences, Vol. 33, Issue 10, October 2010, pp. 474-484.
- Paton JJ, Louie K. Reward and punishment illuminated. Nat Neuroscience (June 2012) V15 No 6, p808-810.
- Hayhow BD, Hassan I, Looi JCL, et al. The neuropsychiatry of hyperkinetic movement disorders: insights from neuroimaging into the neural circuit bases of dysfunction. Tremor Other Hyperkinet Mov 2013; 3: http://tremorjournal.org/article/view/175
If you have any questions please feel free to contact Nancy Boyd at (352) 594-4298 or at email@example.com