Brain Mechanisms Supporting Mindfulness Meditation-Based Chronic Pain Relief

支持基于正念冥想的慢性疼痛缓解的大脑机制

• 批准号: 9918258
• 负责人: Fadel Zeidan
• 金额: $ 39.54万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN DIEGO
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-01-01 至 2023-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9918258
• 关键词: Absence of pain sensation; Acute; Affect; Affective; American; Analgesics; Anterior; Area; Attenuated; Back; Bilateral; Books; Brain; Brain region; Chronic low back pain; Classification; Clinical; Cognitive; Data; Development; Economic Burden; Epidemic; Financial Hardship; Fostering; Foundations; Growth; Health; Individual; Injury; Insula of Reil; Insurance Carriers; Intervention; Knowledge; Laboratories; Leg; Low Back Pain; Magnetic Resonance Imaging; Meditation; Methods; Mindfulness Training; Narcotics; Nociception; Opiate Addiction; Opioid; Outcome; Pain; Pain intensity; Pain-Free; Participant; Patient Self-Report; Patients; Perfusion; Placebos; Prevalence; Process; Randomized; Regimen; Reporting; Reproducibility; Research Activity; Respiration; Sensory; Site; Somatosensory Cortex; Spin Labels; Techniques; Testing; Thalamic structure; Therapeutic; Training; United States; Work; attenuation; base; chronic pain; chronic pain relief; chronic painful condition; cingulate cortex; clinical pain; cognitive control; cognitive reappraisal; cost; cost effective; effective therapy; emotion regulation; evidence base; experience; insight; mindfulness; mindfulness meditation; neuroimaging; neuromechanism; novel; opioid epidemic; opioid misuse; pain patient; pain reduction; pain relief; response; statistics

Project Summary Pain is a multidimensional experience that involves sensory, cognitive and affective factors. The constellation of interactions between these factors renders the treatment of chronic pain challenging and often a financial burden. In fact, chronic pain affects over 100 million Americans and costs the United States approximately $635 billion dollars a year. The widespread use of opioids to treat chronic pain has led to the so-called “opioid epidemic” due to the exponential growth in opioid misuse and addiction. These staggering statistics highlight the importance of developing, testing and validating fast-acting, non-pharmacological approaches to treat pain. Mindfulness meditation is a technique that has been found to significantly reduce pain in experimental and clinical settings. However, lack of mechanistic data and the assumption that extensive meditation training is required to experience analgesia has limited the clinical deployment of this cost-effective and narcotic-free treatment. Recent findings from our laboratory determined that mindfulness meditation, after only four sessions (20 minutes/session) of training, dramatically reduces pain intensity and unpleasantness ratings. Across two functional neuroimaging studies, employing perfusion-based MRI (arterial spin labeling), we found that mindfulness meditation-induced pain relief was associated with greater activation of the right anterior insula (aINS), orbitofrontal (OFC) and subgenual anterior cingulate (sgACC) cortex. We have also found that meditation-related analgesia was associated with significant thalamic deactivation. These findings demonstrate that mindfulness meditation reduces pain through multiple brain mechanisms related to increased cognitive control, emotion regulation and attenuation of ascending nociceptive input. However, these results cannot be generalized to chronic pain because they were associated with healthy, pain-free participants and thermally induced pain. Importantly, the brain mechanisms supporting the modulation of chronic pain by mindfulness meditation remain unknown. Thus, the central aim of the proposed R01 study is to determine the specific mechanisms supporting the modulation of acutely exacerbated chronic low-back pain, the most prevalent and financially burdensome chronic pain condition, by acutely trained mindfulness meditation. We will determine if the neural mechanisms found to attenuate experimentally induced pain by mindfulness meditation (i.e., OFC, sgACC, thalamus) are also associated with modulating chronic low back pain. It is also unknown how much training is required to enhance the hypothesized relationship between the brain mechanisms supporting mindfulness meditation and chronic low-back pain relief. Thus, we will examine if meditation, after longer bouts of meditation training, will increase the hypothesized relationship between meditation-induced brain activation (i.e., OFC, sgACC, aINS) and chronic low back pain relief. The knowledge to be gained from the proposed study will provide novel mechanistic insight to better develop and tailor cognitive interventions to target multiple chronic pain conditions.

项目概要 疼痛是一种多维体验，涉及感觉、认知和情感因素。 这些因素之间的相互作用使得慢性疼痛的治疗具有挑战性，并且通常会带来经济损失 事实上，慢性疼痛影响着超过 1 亿美国人，并给美国造成了约 1 亿美元的损失。 每年 6350 亿美元的阿片类药物被广泛用于治疗慢性疼痛，从而产生了所谓的“阿片类药物”。 由于阿片类药物滥用和成瘾呈指数增长，这些令人震惊的统计数据凸显了“流行病”。 开发、测试和验证快速、非药物治疗疼痛方法的重要性。 正念冥想是一种在实验和实验中被发现可以显着减轻疼痛的技术。 然而，缺乏机制数据以及冥想广泛训练的假设。 需要体验镇痛限制了这种具有成本效益且不含麻醉剂的临床应用 我们实验室的最新研究结果表明，正念冥想只需四次疗程即可。 （20 分钟/次）的训练可显着降低两个人的疼痛强度和不愉快程度。 功能性神经影像研究，采用基于灌注的 MRI（动脉自旋标记），我们发现 冥想引起的疼痛缓解与右前岛叶的更大激活有关 我们还发现，（aINS）、眶额（OFC）和膝下前扣带回（sgACC）皮质。 这些发现表明，冥想相关的镇痛与丘脑的显着失活有关。 冥想通过与增加相关的多种大脑机制来减轻疼痛 然而，这些结果不能被证实。 泛化为慢性疼痛，因为它们与健康、无痛的参与者和热相关 重要的是，大脑机制支持通过正念调节慢性疼痛。 因此，拟议的 R01 研究的中心目标是确定具体的冥想。 支持调节急性加重的慢性腰痛的机制，这是最普遍和最常见的慢性腰痛 通过经过严格训练的正念冥想，我们将确定是否会造成经济负担的慢性疼痛。 发现通过正念冥想减轻实验引起的疼痛的神经机制（即 OFC， sgACC、丘脑）也与调节慢性腰痛相关，但具体程度尚不清楚。 需要训练来增强支持大脑机制之间的发达关系 正念冥想和慢性腰痛缓解因此，我们将在较长时间后检查冥想是否有效。 冥想训练，将增加冥想引起的大脑激活之间的培养关系 （即 OFC、sgACC、aINS）和慢性腰痛缓解 从建议中获得的知识。 研究将提供新颖的机制见解，以更好地开发和定制针对多种目标的认知干预措施 慢性疼痛状况。