Locus of Pain Control: Neural Substrates & Modifiability

疼痛控制部位：神经基质

• 批准号: 7198150
• 负责人: David A Williams
• 金额: $ 50.15万
• 依托单位: UNIVERSITY OF MICHIGAN AT ANN ARBOR
• 依托单位国家: 美国
• 财政年份: 2004
• 资助国家: 美国
• 起止时间: 2004-05-19 至 2009-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7198150
• 关键词: Adherence; Aerobic; Affective; Behavior Therapy; Behavioral; Belief; Biological Neural Networks; Brain; Brain region; Caring; Clinical Research; Cognitive; Cognitive Therapy; Condition; Control Locus; Data; Data Set; Effectiveness; Exercise; Fibromyalgia; Foundations; Functional Magnetic Resonance Imaging; Grant; Image; Individual; Intervention; Investigation; Judgment; Literature; Longitudinal Studies; Magnetic Resonance Imaging; Methods; Modality; Natural History; Neurobiology; Outcome; Pain; Pain management; Patients; Pattern; Process; Protocols documentation; Publications; Randomized; Randomized Controlled Trials; Relaxation; Relaxation Therapy; Standards of Weights and Measures; Stimulus; Symptoms; Testing; Time; Training; Treatment Protocols; Waxes; base; central pain; design; experience; fitness; functional status; improved; insight; psychologic; relating to nervous system; success; tool

DESCRIPTION: Belief in ones ability to control pain through personal effort is associated with better pain management, higher functional status, and better long-term adherence to treatment regimens. While beliefs in pain control appear to be low and stable over time in patients with Fibromyalgia Syndrome (FMS), recent literature and our own pilot investigations suggest that these beliefs may be malleable through behavioral interventions. Theoretically, any change in belief will need to be predicated upon experiencing newfound personal control; thus patients must actually experience successful personal pain control before such beliefs can change. Relatedly, we possess pilot data using functional MRI (fMRI) suggesting that patients with FMS who espouse a strong internal versus external locus of pain control process painful stimuli differently in the cortical brain regions responsible for the experience of pain. To date no clinical studies have specifically focused on beliefs in pain control as a target of treatment nor have studies been conducted that seek the most parsimonious behavioral approach for modifying these beliefs. Similarly, no studies to date have explored whether changing beliefs in pain control will alter central pain processing. Using a randomized controlled design, the proposed study seeks to test the effectiveness of two single modality non-pharmacological methods for modifying beliefs in personal pain control in patients with FMS: prescribed aerobic fitness, and relaxation training. These interventions will be compared to a standard care control condition. Based upon previous literature, both of these interventions should provide a foundation of success experiences attributable to personal effort that would facilitate changing beliefs in pain control. We posit that both interventions will be superior to a standard care only control condition. Moreover, we intend to confirm and extend our pilot fMRI imaging findings suggesting that different neural networks are used by individuals with varying loci of pain control, and then demonstrate that individuals who, through therapy, change their locus of control also have changes in their fMRI patterns of central pain processing. These findings will add to the emerging information on affective and cognitive involvement in higher order pain processing and begin to explain the mechanisms involved in the effectiveness of non-pharmacological interventions that modify beliefs about control.

描述：对通过个人努力控制疼痛的能力的信念与更好的疼痛管理、更高的功能状态以及更好地长期坚持治疗方案相关。虽然纤维肌痛综合征 (FMS) 患者对疼痛控制的信念似乎较低且稳定，但最近的文献和我们自己的试点调查表明，这些信念可能通过行为干预而具有可塑性。从理论上讲，任何信念的改变都需要以经历新的个人控制为基础。因此，在改变这种信念之前，患者必须真正体验到成功的个人疼痛控制。与此相关的是，我们拥有使用功能性 MRI (fMRI) 的初步数据，表明 FMS 患者在负责疼痛体验的皮层大脑区域中，支持强大的内部和外部疼痛控制部位，以不同的方式处理疼痛刺激。迄今为止，还没有临床研究专门关注将疼痛控制信念作为治疗目标，也没有进行研究来寻求最简约的行为方法来改变这些信念。同样，迄今为止还没有研究探讨改变疼痛控制的信念是否会改变中枢疼痛处理。拟议的研究采用随机对照设计，旨在测试两种单一模式非药物方法对改变 FMS 患者个人疼痛控制信念的有效性：规定的有氧健身和放松训练。这些干预措施将与标准护理控制条件进行比较。根据之前的文献，这两种干预措施都应该为个人努力的成功经验奠定基础，从而促进改变疼痛控制的信念。我们认为这两种干预措施都优于仅标准护理控制条件。此外，我们打算确认并扩展我们的初步功能磁共振成像发现，表明具有不同疼痛控制位点的个体使用不同的神经网络，然后证明通过治疗改变其控制位点的个体的功能磁共振成像也会发生变化中枢疼痛处理模式。这些发现将增加关于高阶疼痛处理中情感和认知参与的新信息，并开始解释改变控制信念的非药物干预措施的有效性所涉及的机制。

项目成果

Executive function in chronic pain patients and healthy controls: different cortical activation during response inhibition in fibromyalgia.

• DOI: 10.1016/j.jpain.2011.06.007
• 发表时间: 2011-12
• 期刊: The journal of pain
• 作者: Glass JM;Williams DA;Fernandez-Sanchez ML;Kairys A;Barjola P;Heitzeg MM;Clauw DJ;Schmidt-Wilcke T
• 通讯作者: Schmidt-Wilcke T

Understanding fibromyalgia: lessons from the broader pain research community.

• DOI: 10.1016/j.jpain.2009.06.001
• 发表时间: 2009-08
• 期刊: The journal of pain
• 作者: Williams DA;Clauw DJ
• 通讯作者: Clauw DJ

Internet-enhanced management of fibromyalgia: a randomized controlled trial.

• DOI: 10.1016/j.pain.2010.08.034
• 发表时间: 2010-12
• 期刊: Pain
• 影响因子: 7.4
• 作者: Williams DA;Kuper D;Segar M;Mohan N;Sheth M;Clauw DJ
• 通讯作者: Clauw DJ

Potential mediators of improvement in painful chemotherapy-induced peripheral neuropathy via a web-based cognitive behavioural intervention.

通过基于网络的认知行为干预改善化疗引起的疼痛性周围神经病变的潜在介质。

• DOI: 10.5737/23688076283178183
• 发表时间: 2018
• 期刊: Canadian oncology nursing journal = Revue canadienne de nursing oncologique
• 作者: Knoerl,Robert;Barton,DebraL;Holden,JaneanE;Krauss,JohnC;LaVasseur,Beth;Smith,EllenML
• 通讯作者: Smith,EllenML