Adhering to pain self-management strategies is essential for improving psychobehavioral outcomes in individuals with chronic pain. However, maintaining strong adherence to these treatments, which develop adaptive skills, is often difficult, leading to adverse impacts on both individuals and society. Motivation for behavior change has been identified as a major predictor of treatment adherence, yet despite using behavioral techniques to enhance motivation, nonadherence continues to hinder positive clinical results. This review explores the role of the mesocorticolimbic system—connected to reward processing and motivation in the brain—in shaping treatment motivation among chronic pain patients and its effect on adherence. It reviews evidence supporting motivation as a vital factor in adherence, presents neuroimaging findings that link mesocorticolimbic circuitry to motivation, and examines indications of dysfunction within this system in chronic pain patients. The review proposes a neurobehavioral model for adherence to pain self-management interventions, outlines testable hypotheses, and discusses the potential research and intervention implications that arise from this model.
PainSA is a chapter of the International Association for the Study of Pain. Our mission is to improve all aspects of pain management in Southern Africa.
We are a multidisciplinary society whose membership includes all healthcare professionals