The use of functional neuroimaging to evaluate psychological and other non-pharmacological treatments for clinical pain.
The use of functional neuroimaging to evaluate psychological and other non-pharmacological treatments for clinical pain.
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DOI：
10.1016/j.neulet.2012.03.010
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发表时间：
2012-06-29
影响因子：
2.5
通讯作者：
Gollub RL
中科院分区：
文献类型：
--
作者：
Jensen KB;Berna C;Loggia ML;Wasan AD;Edwards RR;Gollub RL
大量的研究提供了证据，证明心理和其他非药物干预措施在治疗慢性疼痛中的疗效。虽然这些方法越来越多地用于治疗疼痛，但很少有研究关注其神经相关性的探索。本文旨在回顾神经影像学研究的结果，这些研究评估了对基于分心的技术、认知行为疗法（CBT）、临床催眠、心理意象、物理疗法/运动、生物反馈和镜像疗法的神经反应。迄今为止，使用神经影像学来评估这些方法的研究结果尚未得出结论，并且实验方法对于评估临床疼痛而言是次优的。尽管如此，几种不同的心理和非药物治疗方式与执行认知大脑区域（如腹侧和背外侧前额叶皮层）的疼痛相关激活增加有关。还有证据表明，传入疼痛区域和边缘结构中与疼痛相关的激活减少。如果未来的研究将解决当今实验的技术和方法学挑战，神经影像学可能有可能分离不同治疗干预的神经机制，并阐明成功治疗结果的预测和介导因素。对治疗相关的大脑变化（功能和结构）的评估也可能允许对患者进行亚组，并有助于开发个性化治疗。
A large number of studies have provided evidence for the efficacy of psychological and other non-pharmacological interventions in the treatment of chronic pain. While these methods are increasingly used to treat pain, remarkably few studies focused on the exploration of their neural correlates. The aim of this article was to review the findings from neuroimaging studies that evaluated the neural response to distraction-based techniques, cognitive behavioral therapy (CBT), clinical hypnosis, mental imagery, physical therapy/exercise, biofeedback, and mirror therapy. To date, the results from studies that used neuroimaging to evaluate these methods have not been conclusive and the experimental methods have been suboptimal for assessing clinical pain. Still, several different psychological and non-pharmacological treatment modalities were associated with increased painrelated activations of executive cognitive brain regions, such as the ventral- and dorsolateral prefrontal cortex. There was also evidence for decreased pain-related activations in afferent pain regions and limbic structures. If future studies will address the technical and methodological challenges of today’s experiments, neuroimaging might have the potential of segregating the neural mechanisms of different treatment interventions and elucidate predictive and mediating factors for successful treatment outcomes. Evaluations of treatment-related brain changes (functional and structural) might also allow for sub-grouping of patients and help to develop individualized treatments.
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