AUTHOR=Eckert Anna-Lena , Pabst Kathrin , Endres Dominik M. 

TITLE=A Bayesian model for chronic pain

JOURNAL=Frontiers in Pain Research

VOLUME=3

YEAR=2022

URL=https://www.frontiersin.org/journals/pain-research/articles/10.3389/fpain.2022.966034

DOI=10.3389/fpain.2022.966034

ISSN=2673-561X

ABSTRACT=<p>The perceiving mind constructs our coherent and embodied experience of the world from noisy, ambiguous and multi-modal sensory information. In this paper, we adopt the perspective that the experience of pain may similarly be the result of a probabilistic, inferential process. Prior beliefs about pain, learned from past experiences, are combined with incoming sensory information in a Bayesian manner to give rise to pain perception. Chronic pain emerges when prior beliefs and likelihoods are biased towards inferring pain from a wide range of sensory data that would otherwise be perceived as harmless. We present a computational model of interoceptive inference and pain experience. It is based on a Bayesian graphical network which comprises a hidden layer, representing the inferred pain state; and an observable layer, representing current sensory information. Within the hidden layer, pain states are inferred from a combination of priors <inline-formula><mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="IM1"><mml:mi>p</mml:mi><mml:mo stretchy="false">(</mml:mo><mml:mtext>pain</mml:mtext><mml:mo stretchy="false">)</mml:mo></mml:math></inline-formula>, transition probabilities between hidden states <inline-formula><mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="IM2"><mml:mi>p</mml:mi><mml:mo stretchy="false">(</mml:mo><mml:msub><mml:mtext>pain</mml:mtext><mml:mrow><mml:mi>t</mml:mi><mml:mo>+</mml:mo><mml:mn>1</mml:mn></mml:mrow></mml:msub><mml:mo>∣</mml:mo><mml:msub><mml:mtext>pain</mml:mtext><mml:mrow><mml:mi>t</mml:mi></mml:mrow></mml:msub><mml:mo stretchy="false">)</mml:mo></mml:math></inline-formula> and likelihoods of certain observations <inline-formula><mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="IM3"><mml:mi>p</mml:mi><mml:mo stretchy="false">(</mml:mo><mml:mtext>sensation</mml:mtext><mml:mo>∣</mml:mo><mml:mtext>pain</mml:mtext><mml:mo stretchy="false">)</mml:mo></mml:math></inline-formula>. Using variational inference and free-energy minimization, the model is able to learn from observations over time. By systematically manipulating parameter settings, we demonstrate that the model is capable of reproducing key features of both healthy- and chronic pain experience. Drawing on mathematical concepts, we finally simulate treatment resistant chronic pain and discuss mathematically informed treatment options.</p>