Chronic pain and fatigue in musculoskeletal disease contribute significantly to disability, and recent studies suggest an association with reduced motivation and excessive fear avoidance. In this behavioural neuroimaging study in chronic inflammatory arthritis participants and healthy controls, we aimed to identify the specific behavioral and neural changes associated pain and fatigue during reward and loss decision-making. Computational modeling of behaviour identified a parametric signature, characterized most notably by increased punishment sensitivity. This signature is distinct from patterns previously reported in psychiatric conditions and it aligns with predictions of mechanistic models of chronic pain such as the fear avoidance model. Neural activity associated with the punishment prediction error was enhanced in the right posterior insular cortex, putamen, pallidum, and dorsolateral prefrontal cortex. Functional network connectivity analysis showed that insula centrality correlated with subjective reports of fatigue and pain. Overall, the findings show that pain and fatigue in chronic pain relate to objective behavioural changes, and can be mapped to a specific pattern of activity in brain circuits of motivation and decision-making.

中文翻译：

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增强慢性疼痛和疲劳中对惩罚的行为和神经敏感性

肌肉骨骼疾病引起的慢性疼痛和疲劳对残疾有显着影响，最近的研究表明与动机降低和过度回避恐惧有关。在这项针对慢性炎症关节炎参与者和健康对照的行为神经影像研究中，我们的目的是确定奖励和损失决策过程中与疼痛和疲劳相关的特定行为和神经变化。行为的计算模型确定了一个参数特征，最显着的特征是惩罚敏感性的增加。这一特征与之前报道的精神疾病模式不同，并且与慢性疼痛机制模型（例如恐惧回避模型）的预测一致。与惩罚预测错误相关的神经活动在右后岛叶皮质、壳核、苍白球和背外侧前额叶皮质中增强。功能网络连接分析表明，岛叶中心性与疲劳和疼痛的主观报告相关。总体而言，研究结果表明，慢性疼痛中的疼痛和疲劳与客观行为变化有关，并且可以映射到大脑动机和决策回路中的特定活动模式。