Exploring the role of the cerebellum in pain perception: a narrative review

This systematic review aims to reassess the expanding role of the cerebellum in pain perception, challenging its traditional and simplistic association with the motor domain. Pain perception is a complex experience shaped by sensory, emotional, and cognitive factors, with recent findings underlining the cerebellum’s influence over these systems. This paper evaluates findings from 24 relevant studies to elucidate key findings with regard to pain and their potential clinical applications. The cerebellum's role in pain processing is assessed through its interaction with nociceptive pathways, pain anticipation, and the intonation of pain-related emotional responses. Key cerebellar regions such as Crus I, lobules VI and VIII, and the vermis, are persistently activated during pain perception and anticipation. These regions are linked to sensory-discriminative and affective-motivational elements of pain. Studies on patients with migraines, chronic low back pain, and irritable bowel syndrome (IBS) demonstrated increased cerebellar activation, suggesting its role in chronic pain conditions. Non-invasive neurostimulation techniques, such as transcranial direct current stimulation (tDCS) and repetitive transcranial magnetic stimulation (rTMS), administered onto these cerebellar regions, show potential in modulation of pain and clinical application. Future research should aim to standardise methodologies, explore the cerebellum's role in acute pain, and investigate long-term effects of cerebellar-targeted treatments. Understanding the cerebellum's multifaceted role in pain perception can advance diagnostic and therapeutic strategies, offering a more comprehensive approach to pain management. This review underscores the need for further investigation into cerebellar mechanisms and their clinical applications, potentially transforming pain treatment paradigms.