Adherence to pain self-management strategies is associated with favorable psychobehavioral outcomes among individuals with chronic pain. Substantive adherence to treatments teaching these adaptive skills often proves challenging, resulting in poor individual and societal outcomes. Evidence demonstrates motivation for behavior change as a key predictor of treatment adherence. Despite behavioral techniques that target motivation, however, nonadherence persists as a barrier to positive clinical outcomes in chronic pain. Understanding the neurobiological mechanisms underlying treatment motivation might highlight novel avenues for augmentative therapies. The purpose of this review is to present theory and evidence that the mesocorticolimbic system (i.e., brain circuitry associated with reward processing and motivation) contributes to treatment motivation among chronic pain patients, ultimately influencing adherence. We review evidence for motivation as a key adherence determinant, detail neuroimaging findings relating mesocorticolimbic circuitry and motivation, and discuss data supporting mesocorticolimbic dysfunction among chronic pain patients. We propose a neurobehavioral model for adherence to pain self-management interventions, listing testable hypotheses. Finally, we discuss potential research and intervention implications from the proposed model.

中文翻译：

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探索中皮层皮质回路在促进和坚持慢性疼痛自我管理干预措施中的潜在作用。

坚持疼痛自我管理策略与慢性疼痛患者的良好心理行为结果相关。基本上坚持教授这些适应性技能的治疗方法通常被证明具有挑战性，导致个人和社会结果不佳。证据表明，行为改变的动机是治疗依从性的关键预测指标。尽管有针对动机的行为技术，但是，不依从仍然是慢性疼痛积极临床结果的障碍。了解潜在的治疗动机的神经生物学机制可能会强调增强疗法的新途径。这篇综述的目的是介绍中皮层皮质系统（即 与奖励处理和动机相关的大脑电路）有助于慢性疼痛患者的治疗动机，最终影响依从性。我们审查了动机作为关键依从性决定因素的证据，详细介绍了与中皮层皮质回路和动机相关的神经影像学发现，并讨论了在慢性疼痛患者中支持中皮层皮质功能障碍的数据。我们提出了一种遵守疼痛自我管理干预措施的神经行为模型，列出了可检验的假设。最后，我们讨论了所提出模型的潜在研究和干预意义。并讨论了支持慢性疼痛患者中皮层皮质功能障碍的数据。我们提出了一种遵守疼痛自我管理干预措施的神经行为模型，列出了可检验的假设。最后，我们讨论了所提出模型的潜在研究和干预意义。并讨论了支持慢性疼痛患者中皮层皮质功能障碍的数据。我们提出了一种遵守疼痛自我管理干预措施的神经行为模型，列出了可检验的假设。最后，我们讨论了所提出模型的潜在研究和干预意义。