Dissecting Neural Mechanisms Supporting Mind and Body Approaches to Pain Reduction in Youth with Migraine

剖析支持青少年偏头痛减轻疼痛的身心方法的神经机制

• 批准号: 9906854
• 负责人: Robert C Coghill
• 金额: $ 75.79万
• 依托单位: CINCINNATI CHILDRENS HOSP MED CTR
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-04-05 至 2024-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9906854
• 关键词: Address; Adolescent; Adult; Affect; Age; Amitriptyline; Amygdaloid structure; Arousal; Biofeedback; Brain; Brain region; Breathing; Categories; Child; Childhood; Clinical Trials; Cognitive Therapy; Data; Disease; Education; Functional Magnetic Resonance Imaging; Goals; Guided imagery; Headache; Health; Imagery; Intervention; Magnetic Resonance Imaging; Migraine; Mind-Body Intervention; Modality; Multicenter Trials; Muscle Tension; Muscle relaxation phase; Neurobiology; Nociception; Outcome; Pain; Pain Research; Pain management; Patients; Pattern; Performance; Pharmaceutical Preparations; Pharmacology; Phase; Placebos; Play; Prefrontal Cortex; Prevention; Preventive; Process; Recurrence; Regulation; Relaxation; Relaxation Techniques; Relaxation Therapy; Rest; Role; Sampling; Sensory; Spin Labels; Strategic Planning; Testing; Time; Training; Work; Youth; affective neuroscience; barrier to care; clinical practice; cognitive control; cognitive reappraisal; conditioned pain modulation; disability; evidence base; experience; falls; indexing; neuromechanism; pain reduction; pediatric patients; psychologic; recruit; somatosensory; stressor; topiramate

Migraine affects over 6 million children and adolescents in the U.S. and leads to significant pain and disability. Cognitive behavioral therapy (CBT) effectively reduces the number of headache days in pediatric patients. CBT includes distinct components, including mind and body approaches (deep breathing, progressive muscle relaxation, imagery, biofeedback) and cognitive reappraisal training (CR). While the new strategic plan of the National Center for Complementary and Integrated Health highlights “Neurobiological Effects and Mechanisms” as a top scientific priority for non-pharmacological pain research, the brain mechanisms by which components of CBT work remain poorly delineated. To dissect the neural mechanisms engaged by CBT, we will conduct a mechanistic clinical trial to compare a sample of 80 youth (ages 10 to 17) with migraine who receive relaxation training (BART) to 80 who receive CR training. Functional MRI and quantitative sensory testing (QST) data will be obtained before and after intervention (an 8 week period) to address these aims: Aim 1A. Do BART and CR training differentially alter resting brain activation in a fashion related to headache reduction? Our pilot data indicate migraine patients have pro-nociceptive patterns of functional connectivity with the amygdala while CBT produces anti-nociceptive patterns of amygdalar functional connectivity. We hypothesize that BART will preferentially activate the ventromedial prefrontal cortex (vmPFC) while CR training will preferentially activate the dorsolateral prefrontal cortex (dlPFC) and other regions of cognitive control. To test this, arterial spin labeling (ASL) MRI will be used to compare pre vs. post training differences in steady state brain activation in BART and CR groups. Resting state BOLD fMRI will be used to determine if BART and CR training produce differential alterations of the functional connectivity of the vmPFC and dlPFC with the amygdala. Aim 1B. Does active performance of BART and CR differentially recruit activation of the vmPFC and dlPFC? Preliminary data from CBT were obtained during rest and may reflect tonically active consequences of therapy/headache reduction rather than the phasic mechanisms involved during active engagement of BART/CR strategies. To further determine if BART and CR involve distinct brain mechanisms, both ASL and BOLD MRI will be used to compare brain activation and amygdalar functional connectivity during active performance of each treatment vs. rest. Aim 2. Does the efficiency of pain modulation predict headache reduction following BART vs. CR? QST assessment of the efficiency of conditioned pain modulation (CPM) provides an index of the involvement of endogenous pain modulatory mechanisms in both pain conditions and pain treatments. Our preliminary work has shown that low efficiency of CPM is predictive of headache reduction following CBT. However, it remains unknown if BART vs. CR is more effective in the presence of disrupted endogenous pain modulation. Thus, pre-treatment CPM will be used to test the hypothesis that low efficiency of CPM will be differentially predictive of headache reductions following BART vs. CR.

偏头痛影响美国超过600万儿童和青少年，并导致严重的疼痛和残疾。 认知行为疗法（CBT）有效地减少了儿科患者的头痛天数。 CBT包括不同的组成部分，无关紧要的思想和身体方法（深呼吸，进行性肌肉 放松，图像，生物反馈）和认知重新评估培训（CR）。 国家编译和综合健康中心高亮点“神经生物学效应和 机制“作为非药物疼痛研究的最高科学优先级，whwich的大脑机制 CBT工作的组成部分仍然很差。 将进行机械临床，将80名青年（10至17岁）的样本与偏头痛进行比较 接受CR培训的80人接受放松培训（BART）。 测试（QST）数据将在干预之前和之后（为期8周）来解决目的：目标 1A。 我的飞行员数据表明​​偏头痛患者具有功能连接 使用AmazgDala，CBT会产生杏仁核功能连接的抗伤害感受模式 假设BART在CR训练时伴随着腹膜前额叶皮层（VMPFC）激活腹侧前额叶皮层（VMPFC） 将优先激活背面的前额叶皮层（DLPFC）和其他认知控制区域 测试此方法，将使用人工旋转标签（ASL）MRI比较稳定的训练差异与训练后的差异 BART和CR组的状态大脑激活将使用BART和 CR训练会导致VMPFC和DLPFC与该功能的功能连接的不同变化。 杏仁核AIM 1B。 从CBT获得了DLPFC？ 治疗/头痛的修复，而不是积极参与期间涉及的阶段机制 BART/CR策略。 BOLD MRI将用于比较活动期间的大脑激活和杏仁核功能功能 每种治疗的表现与休息2。 降低BART与CR的QST评估条件调制的效率（CPM） 提供了在疼痛条件和 疼痛治疗。我们的初步工作表明CPM的效率低 但是，在CBT之后减少。 内源性疼痛调节。 CPM具有差异性的头痛的效率降低了BART VS。