Stanford CAM Center for Chronic Back Pain

斯坦福 CAM 慢性背痛中心

• 批准号: 8130340
• 负责人: SEAN C MACKEY
• 金额: $ 180万
• 依托单位: STANFORD UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-09-01 至 2016-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8130340
• 关键词: Stanford; CAM; Center; Chronic; Back

DESCRIPTION (provided by applicant): Until recently, it was unclear if people could attain control over specific neural processes to influence their associated perceptions, cognitions and behaviors. Using real-time fMRI (rtfMRI) neurofeedback, we recently demonstrated that healthy subjects and patients with chronic pain can learn to control activity in the anterior cingulate cortex, leading to significant and clinically meaningful reductions in their pain. We propose to extend this exciting finding to patients with chronic low back pain (CLBP). CLBP is a highly prevalent and difficult to treat condition with a pressing need for novel therapies. Although underlying mechanisms in CLBP are not well understood, basic science has revealed that abnormalities in central pain modulatory and emotion regulatory systems play a crucial role. At the same time, a robust clinical literature suggests the value of mind-body therapies (MBTs) and cognitive/emotion regulatory strategies in the management of chronic pain. What is not clear is how the basic and clinical science findings are linked, such that MBTs alter the functioning of the brain systems involved in pain. This project proposes to use rtfMRI neurofeedback as an innovative technique to manipulate key brain systems related to pain and then translate mechanistic findings to optimize clinical therapies for chronic pain. We will advance this critical area by resolving three issues identified in our previous rtfMRI studies: (1) because patients employ different cognitive strategies to modulate brain activity, their activated brain regions and efficacy in learned control vary, (2) multiple brain regions are activated and deactivated during single region feedback control, suggesting control of multiple, distributed regions may be more effective than control of a single region, and (3) significant individual differences exist in how well patients can modulate their brain activity. Therefore, our overall aims are to: (1) characterize CLBP patients' cognitive strategies for optimally controlling single and multiple distributed brain regions, and (2) identify mediators of pain relief due to rtfMRI. Our overall objective is to advance our scientific knowledge of mind-body therapies, specifically how learned control of specific neural processes leads to reduction in chronic pain. PUBLIC HEALTH RELEVANCE: Chronic low back pain is a highly prevalent, debilitating chronic pain condition that presents a terrible burden to affected patients and society as a whole. Our overall goal is to use real-time fMRI neurofeedback to advance our knowledge of the mechanisms of mind-body therapies, specifically, how learned control of specific neural processes leads to reduction in chronic pain and improvement in well-being.

描述（由申请人提供）：直到最近，还不清楚人们是否可以控制特定神经过程以影响其相关的看法，认知和行为。使用实时fMRI（RTFMRI）神经反馈，我们最近证明，健康受试者和患有慢性疼痛的患者可以学习控制前扣带回皮层的活动，从而导致疼痛的显着且临床上有意义的减少。我们建议将这一激动人心的发现扩展到慢性下腰痛患者（CLBP）。 CLBP是一种高度普遍且难以治疗的情况，对新型疗法的需求紧迫。尽管CLBP中的潜在机制尚不清楚，但基础科学表明，中央疼痛调节和情绪调节系统中的异常起着至关重要的作用。同时，强大的临床文献提出了思维体疗法（MBT）和认知/情感调节策略在慢性疼痛管理中的价值。尚不清楚的是如何将基本和临床科学发现联系起来，因此MBT会改变疼痛涉及的大脑系统的功能。该项目建议将RTFMRI神经反馈作为一种创新技术来操纵与疼痛有关的关键大脑系统，然后翻译机械发现，以优化慢性疼痛的临床疗法。我们将通过解决以前的RTFMRI研究中确定的三个问题来推进这一关键领域：（1）由于患者采用不同的认知策略来调节大脑活动，其激活的大脑区域和学习对照中的功效变化，（2）多个大脑区域被激活，并且在单个区域反馈中被激活，并且在多个区域的控制过程中均具有更大的区域，并且在多个区域中可能具有更大的区域，并且可以在多个区域中及其更有效的区域，并且可能是单一的有效性的，并且是单一的有效性的，并且（可能有效的）（均可及其有效性的）（））（））（）（））调节他们的大脑活动。因此，我们的总体目的是：（1）表征CLBP患者的认知策略，可最佳控制单个和多个分布式大脑区域，以及（2）确定由于RTFMRI而导致的疼痛缓解介质。我们的总体目标是促进我们对思维疗法的科学知识，特别是学习对特定神经过程的控制如何导致慢性疼痛减轻。 公共卫生相关性：慢性下背痛是一种高度普遍，令人衰弱的慢性疼痛状况，给受影响的患者和整个社会带来了可怕的负担。我们的总体目标是使用实时fMRI神经反馈来促进我们对思维疗法机制的了解，特别是了解对特定神经过程的控制如何导致慢性疼痛和健康状况的改善减轻。