An evolutionary medicine perspective on pain and its disorders
Open Access
- 23 September 2019
- journal article
- review article
- Published by The Royal Society in Philosophical Transactions B
- Vol. 374 (1785), 20190288
- https://doi.org/10.1098/rstb.2019.0288
Abstract
Enormous progress in understanding the mechanisms that mediate pain can be augmented by an evolutionary medicine perspective on how the capacity for pain gives selective advantages, the trade-offs that shaped the mechanisms, and evolutionary explanations for the system's vulnerability to excessive and chronic pain. Syndromes of deficient pain document tragically the utility of pain to motivate escape from and avoidance of situations causing tissue damage. Much apparently excessive pain is actually normal because the cost of more pain is often vastly less than the cost of too little pain (the smoke detector principle). Vulnerability to pathological pain may be explained in part because natural selection has shaped mechanisms that respond adaptively to repeated tissue damage by decreasing the pain threshold and increasing pain salience. The other half of an evolutionary approach describes the phylogeny of pain mechanisms; the apparent independence of different kinds of pain is of special interest. Painful mental states such as anxiety, guilt and low mood may have evolved from physical pain precursors. Preliminary evidence for this is found in anatomic and genetic data. Such insights from evolutionary medicine may help in understanding vulnerability to chronic pain. This article is part of the Theo Murphy meeting issue ‘Evolution of mechanisms and behaviour important for pain’.Keywords
Funding Information
- Arizona State University
- Health Research and Services Administration, USA
This publication has 80 references indexed in Scilit:
- Evolutionary medicine: its scope, interest and potentialProceedings. Biological sciences, 2012
- Threat detection, precautionary responses, and anxiety disordersNeuroscience & Biobehavioral Reviews, 2011
- Central sensitization: Implications for the diagnosis and treatment of painPain, 2011
- Molluscan Memory of Injury: Evolutionary Insights into Chronic Pain and Neurological DisordersBrain, Behavior and Evolution, 2009
- Cellular and Molecular Mechanisms of PainCell, 2009
- Cortisol pulsatility and its role in stress regulation and healthFrontiers in Neuroendocrinology, 2004
- Calibrating the sociometer: The relational contingencies of self-esteem.Journal of Personality and Social Psychology, 2003
- The ‘Trier Social Stress Test’ – A Tool for Investigating Psychobiological Stress Responses in a Laboratory SettingNeuropsychobiology, 1993
- Biological basis of the behavior of sick animalsNeuroscience & Biobehavioral Reviews, 1988
- Consequences of commitment to and disengagement from incentives.Psychological Review, 1975