Using fMRI to evaluate CBT treatment response for patients with chronic pain

使用功能磁共振成像评估慢性疼痛患者的 CBT 治疗反应

• 批准号: 7587113
• 负责人: Magdalena R Naylor
• 金额: $ 24.93万
• 依托单位: UNIVERSITY OF VERMONT & ST AGRIC COLLEGE
• 依托单位国家: 美国
• 财政年份: 2008
• 资助国家: 美国
• 起止时间: 2008-09-15 至 2010-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7587113
• 关键词: Acute; Acute Pain; Affect; Affective; Aftercare; Amygdaloid structure; Area; Attention; Brain; Brain imaging; Chronic; Clinical; Cognitive Therapy; Complex; Condition; Data; Decision Making; Depressed mood; Development; Educational process of instructing; Emotional; Emotions; Event; Exclusion Criteria; Functional Magnetic Resonance Imaging; Goals; Intervention; Investigation; Magnetic Resonance Imaging; Measures; Modality; Musculoskeletal Pain; Neurobiology; Outcome; Pain; Pain Threshold; Pain management; Participant; Patients; Perception; Personal Satisfaction; Phobic anxiety disorder; Pilot Projects; Process; Psychiatry; Psychotherapy; Public Health; Publishing; Randomized; Recovery; Reporting; Research; Sensory; Short-Form McGill Pain Questionnaire; Somatosensory Cortex; Spiders; Stimulus; Symptoms; Testing; Unipolar Depression; Week; Well in self; chronic pain; emotional experience; emotional stimulus; experience; improved; neural circuit; neuroimaging; neurophysiology; novel; relating to nervous system; response; showing emotion; theories

DESCRIPTION (provided by applicant): The primary goal of this revised R21 application is to investigate whether a psychotherapeutic approach, group Cognitive Behavioral Therapy (CBT), modifies the dysfunctional emotional and sensory neural circuitry associated with chronic pain as examined by functional magnetic resonance imaging (fMRI). We propose to apply previously tested and accepted paradigms for symptom provocation (acute pain and negative emotional stimuli) to investigate CBT effects on neural correlates of chronic pain. Because chronic pain is not just an isolated sensory event but rather a complex sensory and emotional experience, it is reasonable to expect that an intervention which improves chronic pain such as CBT will alter responses to both painful and emotionally provocative stimuli and thus the underlying neural circuitry. The efficacy of a group CBT treatment modality for chronic pain patients has been well established. In addition, our fMRI pilot study results revealed that the exaggerated amygdala response to negative emotional stimuli in chronic pain patients was normalized after 12 weeks of group CBT, suggesting that CBT may affect at least the emotional component of the pain process. Forty subjects who meet inclusion and exclusion criteria for the fMRI study will be randomly assigned to two study conditions: 12-week group CBT Treatment Condition and Attention Control Condition. Each participant will undergo two fMRI examinations (before and after group interventions) to explore two study goals: 1) whether CBT treatment changes the function of brain neural circuity in response to application of acute noxious stimuli and emotional (fearful) stimuli; 2) whether there is a relationship between altered activation in brain areas associated with the attentional, affective, and sensory aspects of chronic pain and quantifiable improvement in clinical measures reported at the conclusion of group CBT. Our approach is novel as there are no published studies that explore the neurobiological effects of psychotherapeutic approaches in chronic pain. By combining a noxious pain stimulation paradigm, an emotional stimulation paradigm, and brain imaging, and putting this approach into a clinical framework, we will open important, new avenues of research on chronic pain. Our approach may represent a valuable strategy for advancing our understanding of the neurobiology of emotional control related to pain and the effects of cognitive-behavioral therapy in the group setting. Measuring directly the effects of CBT on brain function could ultimately improve clinical decision making and contribute to development of the individualized treatment of patients with chronic pain. PUBLIC HEALTH RELEVANCE: This proposed study will test the hypothesis that cognitive-behavioral therapy (CBT) can modify the dysfunctional neural circuitry associated with chronic pain. Because chronic pain is considered a complex sensory and emotional experience we expect that an intervention such as CBT could alter patients' responses to both painful and emotionally provocative stimuli and thus the underlying neural circuitry tested by fMRI. We believe that our paradigm represents a valuable strategy for advancing our understanding of the neurobiology of emotional control related to pain and the effects of CBT in the group setting.

描述（由申请人提供）： 此修订后的R21应用的主要目标是研究心理治疗方法，群体认知行为疗法（CBT）是否修改了功能磁共振成像（FMRI）检查的功能失调的情绪和感觉神经电路。我们建议将先前测试和接受的范式应用于症状挑衅（急性疼痛和阴性情绪刺激），以研究CBT对慢性疼痛神经相关性的影响。由于慢性疼痛不仅是一个孤立的感觉事件，而且是一种复杂的感觉和情感体验，因此可以合理地期望改善慢性疼痛（例如CBT）的干预措施将改变对疼痛和情感上挑衅性刺激的反应，从而改变基本的神经回路。 CBT治疗方式对慢性疼痛患者的疗效已得到很好的确定。此外，我们的fMRI初步研究结果表明，在CBT组12周后，将夸张的杏仁核对慢性疼痛患者的负面情绪刺激的反应进行了归一化，这表明CBT至少可能影响疼痛过程的情绪成分。 FMRI研究符合纳入和排除标准的40名受试者将随机分配给两个研究条件：12周组CBT治疗条件和注意力控制条件。每个参与者将接受两次fMRI检查（小组干预之前和之后），以探讨两个研究目标：1）CBT治疗是否会因响应急性有害刺激和情绪（可怕的）刺激而改变脑神经循环的功能； 2）与慢性疼痛的注意力，情感和感觉方面相关的大脑区域的激活改变与CBT组结束时报告的临床措施的可量化改善之间是否存在关系。我们的方法是新颖的，因为没有发表的研究可以探索慢性疼痛中心理治疗方法的神经生物学作用。通过将有害的疼痛刺激范式结合在一起，情绪刺激范式和大脑成像，并将这种方法置于临床框架中，我们将开放有关慢性疼痛的重要研究途径。我们的方法可能代表了我们对与疼痛有关的情绪控制神经生物学的理解以及在小组环境中认知行为疗法的影响的宝贵策略。直接测量CBT对大脑功能的影响最终可以改善临床决策，并有助于开发慢性疼痛患者的个性化治疗。公共卫生相关性：这项拟议的研究将检验以下假设：认知行为疗法（CBT）可以改变与慢性疼痛相关的功能失调的神经回路。由于慢性疼痛被认为是一种复杂的感觉和情感体验，因此我们期望CBT这样的干预措施可以改变患者对疼痛和情感上挑衅性刺激的反应，从而改变了fMRI测试的潜在神经电路。我们认为，我们的范式代表了一种有价值的策略，用于促进我们对与疼痛有关的情绪控制神经生物学的理解以及CBT在小组环境中的影响。