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

基本信息

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
项目类别：
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

项目摘要

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.

项目摘要疼痛是一种多维体验，涉及感觉，认知和情感因素。星座这些因素之间的相互作用会导致慢性疼痛挑战的治疗，并且通常是财务上的负担。实际上，慢性疼痛会影响超过1亿美国人，并使美国造成大约损失每年6350亿美元。卵毒素用于治疗慢性疼痛的宽度使用导致所谓的“阿片类药物流行病”是由于阿片类药物失误和成瘾的指数增长。这些惊人的统计数据突出显示开发，测试和验证快速作用，非药物治疗疼痛的重要性。正念冥想是一种发现，已发现可以显着减轻实验和临床环境。但是，缺乏机械数据以及广泛的冥想训练的假设是需要体验镇痛的要求限制了这种经济高效且无麻醉的临床部署治疗。我们实验室的最新发现确定了正念冥想，只有四个会议之后（20分钟/疗程）训练大大降低了疼痛强度和不愉快的评分。跨两个功能性神经影像学研究，采用基于灌注的MRI（动脉自旋标记），我们发现正念冥想引起的缓解疼痛缓解与右前绝缘的更大激活有关（ains），眶额（OFC）和亚属前扣带回（SGACC）皮质。我们还发现与冥想相关的镇痛与明显的丘脑失活有关。这些发现证明了正念冥想通过与认知增加有关的多种大脑机制减轻疼痛控制，情绪调节和上升伤害感染输入的衰减。但是，这些结果不能是概括为慢性疼痛，因为它们与健康，无疼痛的参与者和热疼痛相关诱发疼痛。重要的是，通过正念来支持慢性疼痛调节的大脑机制冥想仍然未知。这就是拟议的R01研究的核心目的是确定特定支持调节的机制急性恶化的慢性低下痛疼痛，最普遍，最普遍，经济上燃烧的慢性疼痛状况，通过急性训练的正念冥想。我们将确定是否发现通过正念冥想减弱实验引起的疼痛的神经机制（即OFC， SGACC，Thalamus）也与调节慢性下背痛有关。这也未知多少需要训练以增强支持大脑机制之间的假设关系正念冥想和慢性下背部疼痛缓解。那，我们将检查冥想是否在更长的回合之后冥想训练将增加冥想引起的大脑激活之间的假设关系（即OFC，SGACC，AINS）和慢性下腰痛缓解。从提议中获得的知识研究将提供新颖的机械洞察力，以更好地发展和量身定制认知干预措施以靶向多重慢性疼痛状况。