Cognitive Behavioral Therapy increases pain-evoked activation of the prefrontal cortex in patients with fibromyalgeia
Cognitive Behavioral Therapy increases pain-evoked activation of the prefrontal cortex in patients with fibromyalgeia
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DOI：
10.1016/j.pain.2012.04.010
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发表时间：
2012-07-01
期刊：
影响因子：
7.4
通讯作者：
Ingvar, Martin
中科院分区：
文献类型：
--
作者：
Jensen, Karin B.;Kosek, Eva;Ingvar, Martin
基于认知行为疗法（CBT）的干预措施被广泛用于治疗慢性疼痛，但对这些治疗效果的大脑机制知之甚少。本研究的目的是验证皮质控制理论在慢性疼痛患者中对基于认知的CBT（接受和承诺疗法）的反应的相关性。43名诊断为纤维肌痛综合征的女性患者参加了一项随机、12周、等待名单对照临床试验（CBT n = 25;对照n = 18）。CBT在12个每周一次的会议期间对6名患者进行分组。在治疗前后或12周期间，对压力诱发疼痛的功能性磁共振成像（fMRI）进行评估。在治疗前、治疗后以及治疗结束后3个月进行抑郁和焦虑自评问卷调查。与等待名单对照组相比，接受CBT治疗的患者在患者总体印象变化测量中报告了更大的纤维肌痛改善，并改善了抑郁和焦虑症状。然而，对临床疼痛或疼痛敏感性指标无影响。一项对功能性磁共振成像扫描的分析显示，认知行为疗法导致腹外侧前额叶/外侧眶额皮质（与执行认知控制相关的区域）的激活增加。我们认为CBT通过改变疼痛信号，情绪和认知之间的大脑回路来改变大脑对疼痛的处理;从而增加对执行区域的访问以重新评估疼痛。因此，我们的数据支持我们的假设激活的皮质控制机制，以响应CBT治疗慢性疼痛。(C)2012年国际疼痛研究协会。Elsevier B. V.出版，保留所有权利。
Interventions based on Cognitive Behavioral Therapy (CBT) are widely used to treat chronic pain, but the brain mechanisms responsible for these treatment effects are poorly understood. The aim of this study was to validate the relevance of the cortical control theory in response to an exposure-based form of CBT, Acceptance and Commitment Therapy, in patients with chronic pain. Forty-three female patients diagnosed with fibromyalgia syndrome were enrolled in a randomized, 12-week, waiting-list controlled clinical trial (CBT n = 25; controls n = 18). CBT was administered in groups of six patients during 12 weekly sessions. Functional magnetic resonance imaging (fMRI) during pressure-evoked pain was assessed before and after treatment or the 12-week period. Self-report questionnaires of depression and anxiety were administered pre- and posttreatment as well as 3 months following end of treatment. Patients treated with CBT reported larger improvement of fibromyalgia on the Patient Global Impression of Change measure, and improved depression and anxiety symptoms, compared to the waiting-list controls. However, there were no effects on clinical pain or pain sensitivity measures. An analysis of fMRI scans revealed that CBT led to increased activations in the ventrolateral prefrontal/lateral orbitofrontal cortex; regions associated with executive cognitive control. We suggest that CBT changes the brain's processing of pain through an altered cerebral loop between pain signals, emotions, and cognitions; leading to increased access to executive regions for reappraisal of pain. Our data thereby support our hypothesis about the activation of a cortical control mechanism in response to CBT treatment in chronic pain. (C) 2012 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.