Impact of CBT for Insomnia on Pain Symptoms and Central Sensitization in Fibromyalgia.

CBT 治疗失眠对纤维肌痛疼痛症状和中枢敏化的影响。

• 批准号: 10163918
• 负责人: Christina S McCrae
• 金额: $ 59.41万
• 依托单位: UNIVERSITY OF MISSOURI-COLUMBIA
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-08-27 至 2023-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10163918
• 关键词: Affect; Affective; Aftercare; Anterior; Area; Arousal; Brain; Brain region; Characteristics; Chronic Insomnia; Cognition; Cognitive; Cognitive Therapy; Collection; Dimensions; Exhibits; Feedback; Fibromyalgia; Goals; Healthcare Systems; Inferior frontal gyrus; Insula of Reil; Lateral; Lead; Link; Long-Term Effects; Medial; Mediating; Mediator of activation protein; Methodology; Modeling; Nervous System Physiology; Neuraxis; Neuronal Plasticity; Outcome; Pain; Pattern; Peripheral; Prefrontal Cortex; Public Health; Resolution; Rest; Role; Sleep; Sleep disturbances; Sleeplessness; Stimulus; Stress; Structure; Suggestion; Testing; Thick; Thinness; Time; active comparator; base; blood oxygen level dependent; brief intervention; central sensitization; chronic pain; chronic pain patient; cingulate cortex; cingulate gyrus; clinical pain; cognitive testing; fibromyalgia pain; fibromyalgia patients; gray matter; heart rate variability; improved; improvement on sleep; neuroimaging; neuromechanism; novel; pain processing; pain sensitivity; pain symptom; pilot trial; poor sleep; relating to nervous system; response; sleep health; sleep onset; theories; white matter

PROJECT SUMMARY Chronic pain patients exhibit maladaptive neural plasticity compared to controls. Further, insomnia affects 67-88% of chronic pain patients. We hypothesize that pain processing and sleep share common neural underpinnings and thus, improving sleep may reverse pain related maladaptive neural plasticity and improve clinical pain. The Cognitive Activation Theory of Stress (CATS) provides a model linking chronic insomnia and pain. CATS asserts sustained arousal and lack of arousal resolution (through restful sleep) lead to critical changes in CNS functioning (aka Central Sensitization, CS) that result in increased pain sensitivity. We recently examined cognitive behavioral treatments for insomnia (CBT-I) and pain (CBT-P) in fibromyalgia (FM) patients. We found novel preliminary evidence that improved sleep, decreased pain-related cognitive-affective arousal, and neural plastic changes suggestive of CS reversal (i.e., normalized brain function in pain processing areas) were associated with improved pain following CBT-I. This is the first evidence of its kind. Consistent with CATS, we hypothesize that pain improvements are mediated by improvements in arousal, sleep, and CS immediately following CBT-I. In the trial proposed herein, we examine the novel hypothesis that a sustained feedback loop of improvements in arousal, sleep, and CS will result in sustained (or possibly increased) pain improvements over time. The proposed study has four specific aims. Aim 1 examines the effects of CBT-I on arousal, sleep, and pain in FM patients. Inclusion of peripheral arousal is novel as it was not tested in our previous trial. Aim 2 examines treatment related changes in resting state brain activity as well as neural activation patterns of functional brain networks and Blood-Oxygen-Level Dependent (BOLD) responses to painful stimuli in regions associated with pain processing. Aim 3 investigates the longitudinal impact of treatment on brain structures associated with pain. Aim 4 examines the mediating impact of arousal, sleep, and CS on pain and evaluates whether these mediating effects explain unique variance of pain improvement over and beyond the mediating effects of global or possibly pain- and/or sleep-specific cognitive-affective factors. All hypotheses tested are consistent with our conceptual model – CATS. Public Health Implications: Demonstration that a relatively brief intervention can reverse or even resolve pain related maladaptive neural plasticity, and improve or even resolve clinical pain would have immediate and far-reaching implications for millions of chronic pain sufferers and the US healthcare system and economy.

项目总结