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

基本信息

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
项目类别：
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

项目摘要

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）：本 R01 申请的主要目标是调查心理治疗方法、团体认知行为治疗 (CBT) 加上复发预防计划治疗性互动语音反应 (TIVR) 是否可以改变功能失调的感觉、情绪和认知功能。通过功能磁共振成像（fMRI）检查与慢性疼痛相关的神经回路。我们建议应用先前测试和接受的症状激发范例（急性疼痛、情绪刺激和认知任务）来研究对慢性疼痛的神经相关因素的心理影响。由于慢性疼痛不仅仅是一种孤立的感觉事件，而是一种复杂的感觉、认知和情感体验，因此可以合理地预期，改善慢性疼痛的干预措施（例如应对技能训练和随后的预防复发计划）将改变对刺激性刺激的反应以及潜在的神经回路。我们的试点研究 (R21NIDA) 表明，慢性肌肉骨骼疼痛患者不仅受益于团体 CBT，而且通过使用我们基于电话的复发预防计划 (TIVR)，病情持续改善。此外，我们的功能磁共振成像试点研究结果表明，慢性疼痛患者在接受 CBT 治疗后，岛叶 (IC)、杏仁核和初级体感皮层 (S1) 对唤醒刺激的反应性降低，前额叶皮层和前扣带皮层 (ACC) 的激活增加。这表明 CBT 可能会增加杏仁核和 S1 的皮质抑制，因此可能与疼痛的减轻和体验有关。在此应用中，我们利用独特的机会来获取纵向临床和神经影像数据。符合 fMRI 研究纳入和排除标准的 120 名受试者将被随机分配到两种研究条件：80 至 11 周 CBT 治疗条件和 40 周注意力控制条件。接受团体 CBT 的 80 名受试者将被随机分配至 TIVR 或照常治疗。参与者将接受三项功能磁共振成像检查（基线时、分组后和 TIVR 干预后），以探索两个研究目标：1）心理治疗是否会改变大脑神经回路的功能，以应对急性伤害性刺激、认知任务和情绪刺激的应用； 2) 与慢性疼痛的注意力、情感和感觉方面相关的大脑区域的激活改变与团体 CBT 和 4 个月 TIVR 结束时报告的临床测量的可量化改善之间是否存在关系。我们的方法很新颖，因为还没有已发表的研究探讨心理治疗方法对慢性疼痛的神经生物学影响。通过脑成像联合检查疼痛、情感和认知范式，并在纵向临床框架中实施这种方法，我们将为慢性疼痛研究开辟重要而新颖的途径。公共健康相关性：这项拟议的研究将检验以下假设：CBT 加上复发预防治疗性交互式语音应答 (TIVR) 计划可以改变通过功能磁共振成像 (fMRI) 检查的与慢性疼痛相关的功能失调的感觉、情绪和认知神经回路。随着我们不断发现疼痛体验受到上升和下降通路相互作用的强烈调节，更好地理解这些调节机制对于开发和适当应用有效的治疗非常重要。我们相信我们的研究将对此做出重大贡献。