The dynamic pain connectome

• A dynamic pain connectome represents pain variability encoded in brain communication.
• Specific neural networks contribute to spontaneous pain–attention fluctuations.
• Individual factors and attention contribute to pain connectome disruption in chronic pain.
• Personalized pain therapies may emerge from study of the dynamic pain connectome.

Traditionally, studies of how pain and attention modulate one another involved explicit cognitive-state manipulations. However, emerging evidence suggests that spontaneous brain-wide network communication is intrinsically dynamic on multiple timescales, and attentional states are in constant fluctuation. Here, in light of studies on neural mechanisms of spontaneous attentional fluctuations and pain variability, we introduce the concept of a dynamic ‘pain connectome’ in the brain. We describe how recent progress in our understanding of individual differences in intrinsic attention to pain and neural network dynamics in chronic pain can facilitate development of personalized pain therapies. Furthermore, we emphasize that the dynamics of pain–attention interactions must be accounted for in the contemporary search for a ‘neural signature’ of the pain connectome.