Distinct Mechanisms of Cognitive Behavioral Therapy Effects in Youth with Migraine: Insights from Neuroimaging and Quantitative Sensory Testing (The How and Why Youth with Headaches Get Better Study)

认知行为治疗对偏头痛青少年的影响的独特机制：来自神经影像学和定量感官测试的见解（头痛青少年如何以及为何得到更好的研究）

• 批准号: 9902553
• 负责人: Robert C Coghill
• 金额: $ 60万
• 依托单位: CINCINNATI CHILDRENS HOSP MED CTR
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-04-01 至 2023-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9902553
• 关键词: Address; Adolescent; Adult; Affect; Age; Amitriptyline; Amygdaloid structure; Anxiety; Behavioral; Biological; Brain; Caring; Child; Childhood; Chronic; Cognitive Therapy; Data; Development; Disease; Education; Family; Fostering; Functional Magnetic Resonance Imaging; Headache; Health Personnel; Healthcare; Intervention; Investigation; Learning; Magnetic Resonance Imaging; Measures; Medical; Meditation; Mental Depression; Migraine; Neuraxis; Outcome; Pain; Pain Research; Pain management; Participant; Patients; Pattern; Pharmaceutical Preparations; Pharmacology; Placebo Effect; Placebos; Play; Prefrontal Cortex; Prevention; Randomized; Rest; Role; Self Management; Sensory; Sleep; Spin Labels; Statistical Models; Structure; Techniques; Testing; Time; Work; Youth; barrier to care; base; chronic pain patient; conditioned pain modulation; design; disability; effective therapy; evidence base; follow-up; improved; insight; neuroimaging; neuromechanism; pediatric patients; pill; predicting response; predictive test; psychologic; recruit; sex; shared decision making; social stigma; treatment effect; uptake

Project Summary: The Federal Pain Research Strategy highlights the need for investigation of biological mechanisms that underlie the treatment effects of non-pharmacological interventions in pediatric chronic pain patients. Understanding biological mechanisms can advance the use of effective treatments such as cognitive behavioral therapy (CBT) by providing patients and families with a stronger rationale for treatment, thereby decreasing stigma and increasing confidence in and commitment to the care plan. In addition, mechanstic insights foster patients' ability to effectively participate in shared decision-making and self-management, may provide for more individualized and precise care, and will increase uptake by health care providers, patients, and payors. Neuroimaging and quantitative sensory testing (QST) are techniques that can provide insight into the biological basis for pain treatment effects. This project will study migraine, which affects > 6 million youth in the U.S. Cochrane reviews show that psychological therapies for pediatric headache result in better outcomes than control conditions (56% improved vs. 22% in 714 participants), and our CBT+Amitriptyline Study found that 66% of youth with chronic migraine had a ≥ 50% reduction in headache days compared to 36% in an education control+Amitriptyline (AMI) group. Despite this evidence base, the neural mechanisms supporting the efficacy of CBT for pain remain poorly understood. The lack of mechanistic understanding is a barrier to treatment utilization, particularly given the time, effort, and expense for pediatric migraine patients to receive CBT vs. conventional pharmacological therapy (which in a national trial reduced headache days similar to placebo pill: AMI 52% of participants improved; Placebo 61%). Pilot data from our group demonstrate that: CBT induces changes in brain connectivity/activation, and QST at baseline predicts reduced migraines at 8 weeks. These findings show proof of concept specific to pediatric migraine patients and refined the design of this project, which will recruit 240 youth ages 10 to 17 with migraine to undergo functional MRI and QST before and after 8 weeks of either CBT, placebo, or AMI to address these aims: Aim 1: Does CBT engage brain mechanisms which are distinct from those engaged by pill-based therapy (placebo & AMI)? Aim 2: Are poorer baseline pain modulatory mechanisms measured by QST predictive of greater headache day reduction from CBT vs. pill-based therapy? Exploratory Aims: a. Assess whether brain changes at 8 weeks in those who receive CBT play a mediational role when outcomes are assessed at a 3 month follow-up; b. Test if the findings from Aims 1 and 2 are supported when other pain contextual variables (anxiety, depression, sleep) are included in the statistical models; c. Compare neuroimaging between placebo and AMI; d. All analyses will include age, sex, pubertal status, and brain structural connectivity in the statistical models to assess developmental variables. Pediatric medical and behavioral clinicians can use mechanistic insights from translational investigations such as this project to enhance the care they provide to youth with migraine.

项目摘要： 联邦疼痛研究策略强调了对生物学机制进行调查的需求 基于小儿慢性疼痛患者的非药物干预措施的治疗作用。 了解生物学机制可以提高使用有效治疗（例如认知） 行为疗法（CBT）通过为患者和家庭提供更强的治疗理由，从而 减少污名并增加对护理计划的信心和承诺。另外，机械 见解培养患者有效地参与共同决策和自我管理的能力，可能 提供更多个性化和精确的护理，并将增加医疗保健提供者，患者， 和付款人。神经影像学和定量感官测试（QST）是可以提供深入了解的技术 疼痛治疗效果的生物基础。该项目将研究偏头痛，影响> 600万年轻人 美国Cochrane评论表明，儿科标题的心理疗法会带来更好的结果 比对照条件（在714名参与者中提高了56％比22％），我们的CBT+Amitriptyline研究发现 慢性偏头痛的青年中有66％的年龄降低了50％，而36％ 教育控制+阿米替林（AMI）组。尽管有证据基础，但神经机制支持 CBT对疼痛的效率仍然很少了解。缺乏机械理解是一个障碍 治疗利用，特别是考虑到小儿偏头痛患者接受的时间，精力和费用 CBT与常规药理学疗法（在全国试验中，缩小了类似的标题 安慰剂药：AMI 52％的参与者有所改善；安慰剂61％）。来自我们小组的飞行员数据表明​​： CBT诱导大脑连通性/激活的变化，基线预测下的QST降低了偏头痛的8 几周。这些发现显示了针对小儿偏头痛患者的概念证明，并完善了 该项目将在偏头痛中招募240名10至17岁的青年，以进行功能性MRI和QST 经过8周的CBT，安慰剂或AMI解决这些目的：目标1：CBT会吸引大脑 与基于药丸疗法（安慰剂和AMI）参与的机制不同？目标2：较差 通过QST测量的基线疼痛调节机制可预测较大的标头日减少 CBT与基于药丸的治疗？探索目的：评估大脑在8周时是否在那些人中发生变化 当在3个月的随访中评估结果时，接收CBT发挥了中介作用； b。测试是否 当其他疼痛上下文变量（焦虑，抑郁，睡眠）是AIM 1和2的发现。 包括在统计模型中； c。比较安慰剂和AMI之间的神经影像； d。所有分析都将 在统计模型中包括年龄，性别，青春期状态和大脑结构连接性 发展变量。儿科医疗和行为临床医生可以使用机械见解 诸如该项目之类的翻译投资，以增强他们为偏头痛的青年提供的护理。