The Modulatory Effects of Altruistic Behaviour on the Neural Mechanisms Underlying Comorbid Neuropathic Pain and Depression

Chronic pain and depression co-occur and negatively impact an individual’s quality of life (Bair et al., 2003). Neuropathic pain is caused by a lesion or disease of the somatosensory nervous system (Murnion, 2018), while depression involves persistent sadness and anhedonia (American Psychiatric Association, 2020). According to Cherif et al. (2020), the prevalence of depression in those with chronic pain is 65.5%. The relationship between neuropathic pain and depression is bidirectional, with each condition potentially worsening the other, resulting in reduced functioning and increased disability (Li, 2015). Von Korff (1992) suggests that the severity of neuropathic pain is associated with increased rates of depression, poor self-rated health, higher rates of unemployment, and greater utilisation of opioid medication. Despite these findings, the neurobiological mechanisms underlying the complex relationship between neuropathic pain and depression remain elusive.

While antidepressants, particularly SSRIs, are frequently administered to mitigate the symptoms of comorbid neuropathic pain and depression, their efficacy remains unclear and warrants further investigation (Bair et al., 2003). As a result, there is a growing interest in exploring environmental and socio-behavioural factors as alternative treatments that rely less on pharmaceutical options. In this context, this study aims to investigate the potential of altruistic behaviour as an intervention to alleviate pain associated with comorbid neuropathic pain-depression.

Altruistic behaviour involves actions aimed at promoting the welfare of others, regardless of whether the person performing the behaviour receives any direct benefit (Baston et al., 2011). Such behaviour has been associated with positive outcomes in both physical and emotional domains (Post, 2005). Wang et al. (2019) found that cancer patients who engaged in altruistic behaviours experienced significant reductions in chronic pain, reflected in reduced activity in pain-associated brain regions, suggesting potential modulatory effects at the neural level. Additionally, altruistic behaviour has been shown to positively impact mental health outcomes, reducing symptoms of depression (Post, 2005).

Investigating the interplay between biological, physiological, psychological, and behavioural variables has become commonplace in biological psychology. This approach can offer valuable insights into the complex nature of comorbid conditions such as neuropathic pain-depression (Martucci et al., 2017). To better understand the biological and neural mechanisms underlying this comorbidity, neuroimaging techniques such as fMRI have been widely used to measure brain activity by tracking changes in blood flow (Alomar & Bakhaidar, 2016).

Research using fMRI has identified key brain regions involved in pain perception and modulation, including the somatosensory cortices, the insular cortex, the anterior cingulate cortex, the thalamus, and the prefrontal cortex (Alomar & Bakhaidar, 2016). These regions collectively form the “pain matrix” when activated during pain perception (Reddan & Wager, 2017). Studies suggest that the activation patterns associated with neuropathic pain resemble those of the pain matrix.

Furthermore, research on the co-occurrence of chronic pain and depression has shown that common neural mechanisms may be underlying this comorbidity, including the anterior cingulate cortex, insula, thalamus, amygdala, and dorsolateral prefrontal cortex (Zheng et al., 2021). Moreover, research has shown that altruistic behaviour can modulate neural activity in brain regions involved in pain and depression (Wang et al., 2020). Fallon et al. (2020) found a significant overlap between the neural networks involved in empathy, an aspect of altruistic behaviour, and pain processing.

Given the potential psychological and physiological benefits of altruistic behaviour, this study aims to explore its potential as an intervention to reduce chronic pain associated with comorbid neuropathic pain-depression and improve the overall quality of life for affected individuals.

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