Loss of Effort in Chronic Low-Back Pain Patients: Motivational Anhedonia in Chronic Pain

The motivational and affective properties of chronic pain significantly impact patients lives and response to treatment but remain poorly understood. Most available phenotyping tools of chronic pain affect rely on patients self-report. Here we instead directly studied the willingness of chronic low-back pain (CLBP) patients to expend effort to win monetary rewards available for wins at different probabilities and different levels of difficulties in comparison to matched pain free controls and obtained functional brain imaging on a sub-group of our sample to link behavior to brain properties. We aimed to specifically test for a differential relationship of the functional connectivity in reward and effort related brain networks, and measures of effort in patients and pain free controls. Consistent with the hypothesis of "negative hedonic shift" in chronic pain we observed that CLBP patients are significantly less willing than pain free controls to expend effort to go for high cost/high reward choices and their reported low-back pain intensity predicted increased effort discounting. Furthermore, patients task performance was directly correlated to functional connectivity between the ventral striatum and ventro-medial prefrontal cortex, which are major nodes in the reward processing network. Patients performance was not explained by their self-reported depressive symptoms. Our results present new behavioral evidence characterizing the nature of anhedonia in chronic pain and links it directly to cortico-striatal connectivity highlighting the role of this circuitry in the pathophysiology of chronic pain.