Identifying EEG Markers of Altered Interoceptive Processing in Chronic Pain

识别慢性疼痛中内感受处理改变的脑电图标记

• 批准号: 10606187
• 负责人: Chloe S Zimmerman
• 金额: $ 5.18万
• 依托单位: BROWN UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-06-01 至 2027-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10606187
• 关键词: Acute Pain; Adult; Agreement; Attention; Back; Back Pain; Behavior Therapy; Behavioral; Biological Markers; Brain region; Cardiac; Caring; Central Nervous System; Chronic; Chronic low back pain; Clinical; Complex; Continuity of Patient Care; Data; Diagnosis; Disease; Early identification; Electrocardiogram; Electroencephalography; Electrophysiology (science); Evoked Potentials; Funding; Future; Healthcare Systems; Heart; Impairment; Implant; Integrative Medicine; Interoception; Intervention; Knowledge; Lead; Link; Low Back Pain; Measurement; Measures; Medical; Mentors; Mind-Body Intervention; Modality; Moods; Motivation; National Research Service Awards; Neurostimulation procedures of spinal cord tissue; Noise; Operative Surgical Procedures; Pain; Pain management; Painless; Parents; Participant; Patient Recruitments; Patient Self-Report; Patients; Performance; Peripheral; Persistent pain; Phase; Physicians; Positioning Attribute; Preparation; Prevalence; Probability; Process; Prosencephalon; Qi Gong; Questionnaires; Research; Running; Selection for Treatments; Sensory; Severities; Signal Transduction; Spinal Cord; Spine surgery; Stimulus; Syndrome; Tai Ji; Testing; Time; Training; Treatment Efficacy; Work; attentional modulation; central pain; chronic pain; chronic pain patient; clinically relevant; comparison control; daily pain; data acquisition; design; experience; experimental study; healing; improved; indexing; mindfulness; multimodality; neural; neuromechanism; observational cohort study; opioid epidemic; pain chronification; pain patient; pain perception; pain reduction; pain relief; paired stimuli; patient population; peripheral pain; primary outcome; prospective; psychobiologic; recruit; remediation; response; secondary analysis; secondary outcome; smartphone application; treatment comparison; treatment response

PROJECT SUMMARY: Chronic pain is a complex, medically unexplained disorder that poses enormous burden to both the patient and the healthcare system. In the face of the opioid epidemic, the need for better scientific understanding of the neuro- and psycho-biological underpinnings of chronic pain to guide improved treatment approaches is clear. Non-pharmacological interventions, including contemplative and integrative practices, have shown efficacy in improving pain and bolster efforts to reduce opioid-ergic medical management. These interventions often target the processing of internal painful and non-painful sensory signals, referred to as interoception. Neural processing of interoceptive stimuli overlaps with many of the regions altered in chronic pain, and self-report interoceptive questionnaires and tasks show diminished interoceptive performance in pain patients. However, the translational relevance of interoceptive functioning in pain treatment trajectories has been hindered by the lack of clear tasks and questionnaire measures of interoception. The overall objective of this proposal is to establish whether neural processing of non-painful interoceptive stimuli, namely the heartbeat, is altered in chronic low back pain patients at various stages of treatment and predictive of non-response to invasive peripherally-targeted treatments compared to healthy adults. This NRSA project will identify how electrophysiological dynamics (EEG/ECG) are related to interoceptive processes and pain treatment response using two newly developed, validated, and rigorously controlled interoception tasks that assess neural responses to the heart (Heartbeat-Evoked Potential, HEP). I will systematically test the hypothesis that chronic pain patients will display diminished modulation of the HEP during attention to their heartbeat compared to healthy controls (Aim 1) and impaired interoceptive-exteroceptive integration when an exteroceptive tone previously synchronized with the heartbeat is unexpectedly omitted (Aim 2). I will also test that these measures at baseline can predict non-response to pain intervention. Together, these data will establish whether neural markers of non-painful interoceptive processing could be clinically relevant biomarkers for guiding treatment selection in chronic low back pain, and would have broad implications for the incorporation of behavioral interventions targeting interoceptive processing. In preparation for this NRSA, I have sought out mentors who have expertise in interoceptive tasks, electrophysiology (EEG and ECG) data acquisition, analysis and interpretation, clinical interventional pain management, and complementary and integrative pain care. This proposal was designed to give me the training needed for a future profession as a Pain Management physician conducting research on interoceptive dynamics in chronic pain, and their relation to healing with integrative medicine modalities.

项目摘要： 慢性疼痛是一种复杂的，医学上无法解释的疾病，对患者和 医疗保健系统。面对阿片类药物流行，需要更好地科学理解 慢性疼痛的神经生物和心理生物学基础是指导改进的治疗方法。 非药理学干预措施，包括沉思和综合实践，在 改善疼痛并加强减少阿片类药物医疗管理的努力。这些干预措施通常针对 内部痛苦和非痛苦的感觉信号的处理，称为Intersoception。神经处理 与许多区域在慢性疼痛中发生了变化和自我报告的互感重叠 问卷和任务显示疼痛患者的感受性表现降低。但是，翻译 缺乏明确的任务阻碍了疼痛治疗轨迹中互感功能的相关性 和调查表衡量的措施。 该提案的总体目的是确定非抚摸的神经处理是否存在 刺激，即心跳，在治疗的各个阶段和 与健康的成年人相比，可以预测对侵入性外围靶向治疗的无反应。这个NRSA 项目将确定电生理动力学（EEG/ECG）与感受过程和 使用两个新开发，经过验证和严格控制的间断任务的疼痛治疗反应 评估对心脏的神经反应（心跳诱发的潜力，HEP）。我将系统地测试 假设慢性疼痛患者将在注意力期间显示出HEP的调节减少 与健康对照组（AIM 1）相比，他们的心跳和跨感受感受性受损 当先前与心跳同步的外部感受性语调是出乎意料的 省略（目标2）。我还将测试基线时的这些措施可以预测疼痛的无反应 干涉。这些数据将共同确定非pain际互感处理的神经标记是否 可能是临床上相关的生物标志物，用于指导慢性腰痛的治疗选择，并且会有 对针对互感处理的行为干预措施的结合的广泛含义。在 为此NRSA做准备，我寻找了在互认为任务方面具有专业知识的导师， 电生理学（EEG和ECG）数据获取，分析和解释，临床介入疼痛 管理以及互补和综合疼痛护理。该建议旨在给我培训 作为疼痛管理医师对未来的职业进行研究需要研究的研究 在慢性疼痛中，以及它们与综合医学方式的康复关系。