Can therapy alter CNS processing of chronic pain: A longitudinal study

治疗能否改变中枢神经系统对慢性疼痛的处理：一项纵向研究

• 批准号: 8318560
• 负责人: Magdalena R Naylor
• 金额: $ 62.26万
• 依托单位: UNIVERSITY OF VERMONT & ST AGRIC COLLEGE
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-07-15 至 2015-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8318560
• 关键词: Acute; Acute Pain; Affect; Affective; Aftercare; Amygdaloid structure; Anterior; Area; Attention; Bilateral; Brain; Brain imaging; CNS processing; Chronic; Clinical; Cognition; Cognitive; Cognitive Therapy; Complex; Coping Skills; Data; Depressed mood; Educational process of instructing; Emotional; Emotions; Event; Exclusion Criteria; Functional Magnetic Resonance Imaging; Goals; Insula of Reil; Intervention; Investigation; Joints; Learning; Longitudinal Studies; Measures; Medial; Modality; Musculoskeletal Pain; National Institute of Arthritis and Musculoskeletal and Skin Diseases; Neurobiology; Outcome; Pain; Pain management; Parietal Lobe; Participant; Pathway interactions; Patients; Perception; Performance; Personal Satisfaction; Phobic anxiety disorder; Pilot Projects; Prefrontal Cortex; Prevention program; Process; Psychiatry; Psychotherapy; Publishing; Randomized; Recovery; Reporting; Research; Sensory; Short-Form McGill Pain Questionnaire; Somatosensory Cortex; Spiders; Stimulus; Symptoms; Task Performances; Telephone; Testing; Therapeutic; Therapeutic Effect; Time; Unipolar Depression; Voice; base; chronic pain; cingulate cortex; clinical decision-making; disorder later incidence prevention; effective therapy; emotional experience; emotional stimulus; experience; improved; inclusion criteria; meetings; neural circuit; neuroimaging; neurophysiology; novel; programs; psychologic; public health relevance; relating to nervous system; response; showing emotion; skills training; standard care; theories; treatment as usual

DESCRIPTION (provided by applicant): The primary goal of this R01 application is to investigate whether a psychotherapeutic approach, group Cognitive Behavioral Therapy (CBT) plus relapse prevention program Therapeutic Interactive Voice Response (TIVR), modifies the dysfunctional sensory, emotional, and cognitive neural circuitry associated with chronic pain as examined by functional magnetic resonance imaging (fMRI). We propose to apply previously tested and accepted paradigms for symptom provocation (acute pain, emotional stimuli and cognitive tasks) to investigate psychological effects on neural correlates of chronic pain. Because chronic pain is not just an isolated sensory event but rather a complex sensory, cognitive and emotional experience, it is reasonable to expect that an intervention which improves chronic pain such as coping skills training followed by the relapse prevention program will alter responses to provocative stimuli and thus the underlying neural circuitry. Our pilot study (R21NIDA) demonstrated that patients with chronic musculoskeletal pain not only benefit from group CBT but continue to improve with the use of our telephone based relapse prevention program (TIVR). In addition, our fMRI pilot study results reveal that after group CBT chronic pain patients show reduced insula (IC), amygdala and primary somatosensory cortex (S1) reactivity to arousing stimuli, and increased activation in the prefrontal cortex and anterior cingulate cortex (ACC). This suggests that CBT may increase cortical suppression of amygdala and S1 and thus may be related to the reduction and the experience of pain. In this application we take advantage of the unique opportunity to obtain longitudinal clinical and neuroimaging data. One hundred twenty subjects who meet inclusion and exclusion criteria for the fMRI study will be randomly assigned to two study conditions: Eighty to 11-week CBT Treatment Condition and forty to Attention Control Condition. Eighty subjects who undergo group CBT will be randomized to TIVR or Treatment-as-Usual. Participants will undergo three fMRI examinations (at baseline, after group and after TIVR interventions) to explore two study goals: 1) whether psychological treatment changes the function of brain neural circuitry in response to application of acute noxious stimuli, cognitive tasks and emotional stimuli; 2) whether there is a relationship between altered activation in brain areas associated with the attentional, affective, and sensory aspects of chronic pain and quantifiable improvement in clinical measures reported at the conclusion of group CBT and 4 months of TIVR. Our approach is novel as there are no published studies that explore the neurobiological effects of psychotherapeutic approaches in chronic pain. Through the joint examination of painful, emotional, and cognitive paradigms via brain imaging and implementing this approach in a longitudinal, clinical framework, we will open important and novel avenues of research on chronic pain. PUBLIC HEALTH RELEVANCE: This proposed study will test the hypothesis that CBT plus relapse prevention Therapeutic Interactive Voice Response (TIVR) program modifies the dysfunctional sensory, emotional, and cognitive neural circuitry associated with chronic pain as examined by functional magnetic resonance imaging (fMRI). As we continue to discover that pain experience is strongly modulated by interactions of ascending and descending pathways, better understanding these modulatory mechanisms is of great importance for developing and appropriately applying effective treatment. We believe that our study will significantly contribute to this.

描述（由申请人提供）：此R01应用的主要目标是调查心理治疗方法，群体认知行为治疗（CBT）以及预防复发计划治疗性互动语音反应（TIVR）是否会改变功能障碍的感官，情感性，情绪和认知神经循环，与慢性疼痛相关联（通过功能上的静态疼痛）（FAINCTINAL IMPENANANCE）（FMENANCE）（FMENANES）（FMENANCE）（FM）（FMRI）（FMRI）（FMRI）（FMRI）。我们建议将先前测试和接受的范式应用于症状挑衅（急性疼痛，情绪刺激和认知任务），以研究对慢性疼痛神经相关性的心理影响。由于慢性疼痛不仅是一个孤立的感官事件，而且是一种复杂的感觉，认知和情感体验，因此可以合理地期望一种改善慢性疼痛的干预措施，例如应对技巧训练，然后进行预防复发计划会改变对挑衅性刺激的反应，从而改变潜在的神经电路。我们的试点研究（R21NIDA）表明，患有慢性肌肉骨骼疼痛的患者不仅受益于CBT组，而且还可以通过使用基于电话的预防复发计划（TIVR）来改善。此外，我们的fMRI初步研究结果表明，在CBT组慢性疼痛后，患者显示出对唤醒刺激的反应性降低（IC），杏仁核和原发性体感皮层（S1）的反应性，并增加了前额叶皮层和前扣带皮层的激活。这表明CBT可能会增加对杏仁核和S1的皮质抑制，因此可能与疼痛的减少和经历有关。在此应用中，我们利用独特的机会来获得纵向临床和神经影像学数据。符合功能磁共振成像研究的纳入和排除标准的一百二十名受试者将随机分配给两个研究条件：八十至11周的CBT治疗条件，以及40个针对注意力控制条件。经历CBT组的80名受试者将被随机分为TIVR或通常情况。参与者将接受三项fMRI检查（基线，组后和TIVR干预后），以探讨两个研究目标：1）心理治疗是否会改变脑神经回路的功能，以响应急性有害刺激，认知任务和情绪刺激的应用； 2）在与注意力，情感和感官方面相关的大脑区域的激活改变与慢性疼痛的注意力和感觉方面相关的激活与在CBT组结束时报告的临床措施的可量化和可量化的改善之间存在关系。 我们的方法是新颖的，因为没有发表的研究可以探索慢性疼痛中心理治疗方法的神经生物学作用。通过通过大脑成像对痛苦，情感和认知范式进行联合检查，并在纵向的临床框架中实施这种方法，我们将开放有关慢性疼痛研究的重要而新颖的研究途径。 公共卫生相关性：这项拟议的研究将检验以下假设：CBT加上预防治疗性互动语音反应（TIVR）程序可修饰通过功能磁共振成像（FMRI）检查的功能失调的感觉，情感和认知神经回路与慢性疼痛相关的慢性疼痛。随着我们继续发现疼痛经历受到上升和下降途径的相互作用的强烈调节，更好地了解这些调节机制对于开发和适当应用有效治疗非常重要。我们认为，我们的研究将为此做出重大贡献。