Cognitive-behavioral therapy increases prefrontal cortex gray matter in patients with chronic pain.
Cognitive-behavioral therapy increases prefrontal cortex gray matter in patients with chronic pain.
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DOI：
10.1016/j.jpain.2013.07.020
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发表时间：
2013-12
期刊：
影响因子：
4
通讯作者：
Naylor, Magdalena R.
中科院分区：
文献类型：
--
作者：
Seminowicz, David A.;Shpaner, Marina;Keaser, Michael L.;Krauthamer, G. Michael;Mantegna, John;Dumas, Julie A.;Newhouse, Paul A.;Filippi, Christopher G.;Keefe, Francis J.;Naylor, Magdalena R.
几项研究报告了慢性疼痛条件下大脑灰质（GM）体积/密度的减少，但对人类大脑皮层对心理干预的可塑性的研究有限。我们调查了慢性疼痛患者认知行为治疗（CBT）后GM的变化。我们使用基于体素的形态测量法（VBM）比较了13名患有混合慢性疼痛类型的患者在11周CBT治疗前后的解剖MRI扫描，以及13名健康对照参与者。CBT导致临床措施的显着改善。在大脑的任何地方，患者与健康对照组的GM没有差异。治疗后，患者双侧背外侧前额叶（DLPFC）、后顶叶（PPC）、膝下前扣带回（ACC）/眶额和感觉运动皮质以及海马的GM增加，辅助运动区的GM减少。在大多数显示GM增加的地区，GM明显高于对照地区。疼痛灾难化的减少与左侧DLPFC和腹外侧前额叶（VLPFC），右侧PPC，体感皮层和前膝ACC. While未来的研究需要额外的对照组来确定CBT对GM和脑功能的具体作用，我们提出，PFC和PPC中GM的增加反映了对疼痛的自上而下的控制和对疼痛的认知重新评估，躯体感觉皮层的变化反映了对有害信号感知的改变。为期11周的CBT干预治疗慢性疼痛导致前额叶和躯体感觉脑区灰质体积增加，以及背外侧前额叶体积增加，与疼痛灾难化减少相关。这些结果增加了越来越多的证据，表明CBT可以成为慢性疼痛的一种有价值的治疗选择。
Several studies have reported reduced cerebral gray matter (GM) volume/density in chronic pain conditions, but there is limited research on plasticity of the human cortex in response to psychological interventions. We investigated GM changes after cognitive behavioral therapy (CBT) in patients with chronic pain. We used voxel based morphometry (VBM) to compare anatomical MRI scans of 13 patients with mixed chronic pain types before and after an 11-week CBT treatment and to 13 healthy control participants. CBT led to significant improvements in clinical measures. Patients did not differ from healthy controls in GM anywhere in the brain. After treatment, patients had increased GM in bilateral dorsolateral prefrontal (DLPFC), posterior parietal (PPC), subgenual anterior cingulate (ACC)/orbitofrontal, and sensorimotor cortices, as well as hippocampus, and reduced GM in supplementary motor area. In most of these areas showing GM increases, GM became significantly higher than in controls. Decreased pain catastrophizing was associated with increased GM in left DLPFC and ventrolateral prefrontal (VLPFC), right PPC, somatosensory cortex, and pregenual ACC. While future studies with additional control groups will be needed to determine the specific roles of CBT on GM and brain function, we propose that increased GM in the PFC and PPC reflects greater top-down control over pain and cognitive reappraisal of pain, and that changes in somatosensory cortices reflect alterations in the perception of noxious signals. An 11-week CBT intervention for coping with chronic pain resulted in increased gray matter volume in prefrontal and somatosensory brain regions, as well as increased dorsolateral prefrontal volume associated with reduced pain catastrophizing. These results add to mounting evidence that CBT can be a valuable treatment option for chronic pain.
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影响因子：
3.7
作者：
Connolly CG;Bell RP;Foxe JJ;Garavan H
通讯作者：
Garavan H
DOI：
10.1073/pnas.0504136102
发表时间：
2005-07-05
影响因子：
11.1
作者：
Fox, MD;Snyder, AZ;Raichle, ME
通讯作者：
Raichle, ME
影响因子：
5.7
作者：
Hayasaka, S;Phan, KL;Nichols, TE
通讯作者：
Nichols, TE
影响因子：
5.3
作者：
Baliki, Marwan N.;Chialvo, Dante R.;Apkarian, A. Vania
通讯作者：
Apkarian, A. Vania
影响因子：
5.3
作者：
Apkarian, AV;Sosa, Y;Gitelman, DR
通讯作者：
Gitelman, DR