Brain Imaging and Pain: Analysis of Placebo Analgesia

脑成像和疼痛：安慰剂镇痛分析

• 批准号: 9929722
• 负责人: Michael E ROBINSON
• 金额: $ 0.73万
• 依托单位: UNIVERSITY OF FLORIDA
• 依托单位国家: 美国
• 财政年份: 2003
• 资助国家: 美国
• 起止时间: 2003-03-15 至 2022-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9929722
• 关键词: Absence of pain sensation; Accounting; Adult; Affect; American; Anterior; Brain; Brain Stem; Brain imaging; Brain region; Cerebrum; Cervical spine; Ethics; Expectancy; Experimental Designs; Functional Magnetic Resonance Imaging; Institute of Medicine (U.S.); Insula of Reil; Intervention; Investigation; Ipsilateral; Literature; Mediating; Memory; Methods; Midbrain structure; Modeling; Music; Nervous system structure; Opioid; Pain; Pain management; Participant; Pathway interactions; Patient Recruitments; Patients; Peer Review; Peripheral Nervous System; Placebos; Posterior Horn Cells; Prefrontal Cortex; Price; Procedures; Productivity; Public Health; Publications; Publishing; Quality of life; Research; Research Design; Research Personnel; Role; Sensory; Somatosensory Cortex; Spinal; Spinal Cord; Spinal cord posterior horn; Spine pain; Stimulus; Suggestion; Testing; Thalamic structure; United States; Wages; Work; addiction; base; chronic pain; chronic pain patient; chronic painful condition; cingulate cortex; clinical practice; cognitive function; cost; design; dorsal horn; endogenous opioids; executive function; experience; heat stimulus; improved; innovation; interest; midbrain central gray substance; neuroimaging; novel strategies; pain processing; pain reduction; relating to nervous system; response; somatosensory; spinal cord imaging

Chronic pain represents a significant public health concern, affecting over 100 million adults, and accounting for over $600 billion US annually. Current treatments for chronic pain lack efficacy, and opioid treatments have led to a significant misuse, addiction, and secondary public health crisis. We have shown that endogenous pain modulation, in the form of “placebo” manipulations have a now well-defined neural underpinning, suggestive of descending pain modulation within and perhaps from the brain to lower nervous system. Our work has identified placebo as a potentially acceptable intervention for patients with chronic pain either as a method to enhance existing treatments, or perhaps as a stand-alone treatment. To date, the contribution of spinal cord mechanisms to placebo analgesia has been largely speculative. We propose to investigate specific hypotheses about both brain and spinal cord mechanisms, and their interactions to a model of placebo analgesia through the use of functional magnetic resonance imaging (FMRI). The neural imaging of the spinal cord is an innovative new approach heretofore not feasible for the investigation of placebo mechanisms. We will combine this new approach with our previously published, and well articulated placebo manipulation and experimental design that will allow us to investigate the relative contribution of brain and cord mechanisms in placebo analgesia. We will employ both traditional fMRI, as well as functional connectivity analyses to investigate relationships among a priori regions of interest in the brain and the spinal cord. Our innovative research design, previously employed with only brain imaging, will allow for the investigation of more centrally dependent mechanisms, vs. those that are more peripheral nervous system dependent. Our team of investigators has all the necessary expertise in chronic pain, pain processing, quantitative sensory testing, neuroimaging, and experimental design to successfully accomplish the aims proposed in this application. We have repeatedly shown our ability to successfully recruit participants for the proposed design, and have successfully employed all the procedures, either in peer reviewed publications, or as demonstrated in our preliminary studies. One critical finding from our previous work has shown that the acceptability of placebo interventions is the empirical support and understanding of the mechanisms of placebo. Thus, in addition to developing a complete understanding of the mechanisms of placebo that might results in new treatment approaches, being able to describe these mechanisms to the public, pain practitioners, and to patients will increase the acceptability of them in clinical practice, thus improving pain treatment.

慢性疼痛代表着一个重大的公共卫生问题，影响了1亿多名成年人， 每年占美国6000亿美元的超过6000亿美元。目前缺乏慢性疼痛的治疗 有效性和阿片类药物治疗导致了重大的失误，成瘾和中学公众 健康危机。我们已经表明，内源性疼痛调节，以“安慰剂”的形式 操纵具有现在定义明确的神经基础，暗示着疼痛下降 内部和可能从大脑到较低神经系统的调节。我们的工作已经确定 安慰剂作为慢性疼痛患者的潜在可接受的干预措施 增强现有治疗方法，或者可能是独立治疗方法。迄今为止， 脊髓机制对安慰剂镇痛的贡献在很大程度上是投机性的。我们 提议研究有关大脑和脊髓机制的特定假设，以及 通过使用功能磁性，它们与安慰剂镇痛模型的相互作用 共振成像（fMRI）。脊髓的神经成像是一种创新的新型 迄今为止，对于安慰剂机制的投资不可行。我们将结合 这种新方法，我们先前发表的，且明确的安慰剂操纵和 实验设计将使我们能够研究大脑和绳索的相对贡献 安慰剂镇痛的机制。我们将同时使用传统的fMRI以及功能 连通性分析以研究大脑感兴趣的先验区域之间的关系 和脊髓。我们的创新研究设计，以前仅与大脑合作 成像，将允许投资更依赖于中心的机制 是外周神经系统依赖的。我们的调查人员团队有必要的 慢性疼痛，疼痛处理，定量感觉测试，神经影像学和 实验设计，以成功完成本应用程序中提出的目标。我们有 反复显示我们成功招募参与者的能力，并 在同行审查的出版物中，成功携带了所有程序，或 在我们的初步研究中证明。我们以前的工作中的一个关键发现已经表明 安慰剂干预的可接受性是对 安慰剂机制。除了对 安慰剂机制可能导致新的治疗方法，能够描述 这些机制向公众，疼痛从业人员和患者提供的机制将增加可接受性 它们在临床实践中，从而改善疼痛治疗。