Behavioral therapy: emotion and pain, a common anatomical background

Emotion and pain are closely intertwined in the brain, as the human experience of pain includes both affective and nociceptive components. Although each of these components relies on a different system in the brain, the two systems converge on the anterior cingulate and insular cortices, which interact with the prefrontal cortex and other frontal structures to influence behavior. Both emotional and physical pain elicit activity in these common areas, and conditions that affect one system (e.g., drugs, neural plasticity) may affect the function of the other—ultimately altering the experience of pain. Changes in these areas and their connections may even contribute to the chronification of pain. This relationship should not be overlooked in the treatment of painful conditions, including headache. Nonpharmacological therapies, such as cognitive behavioral therapy, yoga, biofeedback, and meditation, that are often used for enhancing emotional regulation, are increasingly being turned to for augmenting management of migraine and pain. Because of the overlap between emotion and pain, these therapies are likely acting through similar mechanisms, and emotional cues can be sensitive indicators of treatment-related changes in patients.