Brain Mechanisms Supporting Mindfulness Meditation-Based Chronic Pain Relief

支持基于正念冥想的慢性疼痛缓解的大脑机制

• 批准号: 10395454
• 负责人: Fadel Zeidan
• 金额: $ 39.49万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN DIEGO
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-01-01 至 2024-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10395454
• 关键词: Absence of pain sensation; Acute; Affect; Affective; American; Analgesics; Anterior; Area; Attenuated; Back; Bilateral; Books; Brain; Brain region; Chronic low back pain; Classification; Clinical; Cognitive; Data; Development; Economic Burden; Epidemic; Financial Hardship; Fostering; Foundations; Growth; Health; Individual; Injury; Insula of Reil; Insurance Carriers; Intervention; Laboratories; Leg; Low Back Pain; Magnetic Resonance Imaging; Meditation; Methods; Mindfulness Training; Narcotics; Nociception; Opiate Addiction; Opioid; Outcome; Pain; Pain intensity; Pain-Free; Participant; Patient Self-Report; Patients; Perfusion; Placebos; Prevalence; Process; Randomized; Regimen; Reporting; Reproducibility; Research Activity; Respiration; Sensory; Site; Somatosensory Cortex; Techniques; Testing; Thalamic structure; Therapeutic; Training; United States; Work; arterial spin labeling; attenuation; base; chronic pain; chronic pain management; chronic pain relief; chronic painful condition; cingulate cortex; clinical pain; cognitive control; cognitive reappraisal; cost; cost effective; effective therapy; emotion regulation; evidence base; experience; insight; mindfulness; mindfulness meditation; neuroimaging; neuromechanism; novel; opioid epidemic; opioid misuse; pain patient; pain reduction; pain relief; response; statistics

Pain is a multidimensional experience that involves sensory, cognitive and affective factors. The constellation of interactions between these factors renders the treatment of chronic pain challenging and often a financial burden. In fact, chronic pain affects over 100 million Americans and costs the United States approximately $635 billion dollars a year. The widespread use of opioids to treat chronic pain has led to the so-called “opioid epidemic” due to the exponential growth in opioid misuse and addiction. These staggering statistics highlight the importance of developing, testing and validating fast-acting, non-pharmacological approaches to treat pain. Mindfulness meditation is a technique that has been found to significantly reduce pain in experimental and clinical settings. However, lack of mechanistic data and the assumption that extensive meditation training is required to experience analgesia has limited the clinical deployment of this cost-effective and narcotic-free treatment. Recent findings from our laboratory determined that mindfulness meditation, after only four sessions (20 minutes/session) of training, dramatically reduces pain intensity and unpleasantness ratings. Across two functional neuroimaging studies, employing perfusion-based MRI (arterial spin labeling), we found that mindfulness meditation reduces pain through multiple brain mechanisms related to increased cognitive control, emotion regulation and attenuation of ascending nociceptive input. However, these results cannot be generalized to chronic pain because they were associated with healthy, pain-free participants and thermally induced pain. Importantly, the brain mechanisms supporting the modulation of chronic pain by mindfulness meditation remain unknown. Thus, the central aim of the proposed R01 study is to determine the specific mechanisms supporting the modulation of acutely exacerbated chronic low-back pain, the most prevalent and financially burdensome chronic pain condition, by acutely trained mindfulness meditation. We will determine if the neural mechanisms found to attenuate experimentally induced pain by mindfulness meditation (i.e., OFC, sgACC, thalamus) are also associated with modulating chronic low back pain. The neurofunctional connections supporting mindfulness-based pain relief are also unknown. Thus, we will also examine if mindfulness-based pain relief is associated with thalamic-default mode network decoupling to provide mechanistic insight to better develop interventions to target pain.

疼痛是一种涉及感觉、认知和情感因素的多维体验。这些因素之间的相互作用使得慢性疼痛的治疗具有挑战性，并且通常是经济负担。事实上，慢性疼痛影响超过1亿美国人，每年花费美国约6350亿美元。阿片类药物治疗慢性疼痛的广泛使用导致了所谓的“阿片类药物流行病”，这是由于阿片类药物滥用和成瘾的指数增长。这些惊人的统计数据突出了开发，测试和验证快速起效的非药物方法来治疗疼痛的重要性。正念冥想是一种在实验和临床环境中显着减少疼痛的技术。然而，缺乏机械数据和假设，需要广泛的冥想训练来体验镇痛，限制了这种具有成本效益和无麻醉治疗的临床部署。我们实验室最近的研究结果表明，在仅仅四次训练（每次20分钟）之后，正念冥想就能显著降低疼痛强度和不愉快程度。在两项功能性神经成像研究中，采用基于灌注的MRI（动脉自旋标记），我们发现正念冥想通过多种大脑机制减少疼痛，这些机制与增加认知控制，情绪调节和减弱上升的伤害性输入有关。然而，这些结果不能推广到慢性疼痛，因为它们与健康、无疼痛的参与者和热诱发疼痛有关。重要的是，支持正念冥想调节慢性疼痛的大脑机制仍然未知。因此，拟议的R01研究的中心目的是确定支持通过急性训练的正念冥想调节急性加重的慢性腰痛的具体机制，这是最普遍和经济负担最重的慢性疼痛状况。我们将确定是否发现神经机制可以通过正念冥想减弱实验诱导的疼痛（即，OFC、sgACC、丘脑）也与调节慢性腰痛有关。支持基于正念的疼痛缓解的神经功能连接也是未知的。因此，我们还将研究基于正念的疼痛缓解是否与丘脑默认模式网络解耦相关，以提供机制洞察力，从而更好地开发针对疼痛的干预措施。