Distinct Mechanisms of Cognitive Behavioral Therapy Effects in Youth with Migraine: Insights from Neuroimaging and Quantitative Sensory Testing (The How and Why Youth with Headaches Get Better Study)
认知行为治疗对偏头痛青少年的影响的独特机制:来自神经影像学和定量感官测试的见解(头痛青少年如何以及为何得到更好的研究)
基本信息
- 批准号:10395448
- 负责人:
- 金额:$ 60.31万
- 依托单位:
- 依托单位国家:美国
- 项目类别:
- 财政年份:2018
- 资助国家:美国
- 起止时间:2018-04-01 至 2024-03-31
- 项目状态:已结题
- 来源:
- 关键词:AddressAdolescentAdultAffectAgeAmitriptylineAmygdaloid structureAnxietyBehavioralBiologicalBrainCaringChildChildhoodChronicCognitive TherapyDataDevelopmentDiseaseEducationFamilyFosteringFunctional Magnetic Resonance ImagingHeadacheHealth PersonnelHealthcareInterventionInvestigationLearningMagnetic Resonance ImagingMeasuresMedicalMeditationMental DepressionMigraineNeuraxisOutcomePainPain ResearchPain managementParticipantPatientsPatternPharmaceutical PreparationsPharmacologyPlacebo EffectPlacebosPlayPrefrontal CortexPreventionRandomizedRestRoleSelf ManagementSensorySleepStatistical ModelsStructureTechniquesTestingTimeWorkYoutharterial spin labelingbarrier to carebasechronic pain patientconditioned pain modulationdesigndisabilityeffective therapyevidence basefollow-upimprovedinsightmigraine treatmentneuroimagingneuromechanismpediatric patientspillpredict responsivenesspredicting responsepredictive testpsychologicrecruitsexshared decision makingsocial stigmatreatment effectuptake
项目摘要
Project Summary:
The Federal Pain Research Strategy highlights the need for investigation of biological mechanisms that
underlie the treatment effects of non-pharmacological interventions in pediatric chronic pain patients.
Understanding biological mechanisms can advance the use of effective treatments such as cognitive
behavioral therapy (CBT) by providing patients and families with a stronger rationale for treatment, thereby
decreasing stigma and increasing confidence in and commitment to the care plan. In addition, mechanstic
insights foster patients' ability to effectively participate in shared decision-making and self-management, may
provide for more individualized and precise care, and will increase uptake by health care providers, patients,
and payors. Neuroimaging and quantitative sensory testing (QST) are techniques that can provide insight into
the biological basis for pain treatment effects. This project will study migraine, which affects > 6 million youth in
the U.S. Cochrane reviews show that psychological therapies for pediatric headache result in better outcomes
than control conditions (56% improved vs. 22% in 714 participants), and our CBT+Amitriptyline Study found
that 66% of youth with chronic migraine had a ≥ 50% reduction in headache days compared to 36% in an
education control+Amitriptyline (AMI) group. Despite this evidence base, the neural mechanisms supporting
the efficacy of CBT for pain remain poorly understood. The lack of mechanistic understanding is a barrier to
treatment utilization, particularly given the time, effort, and expense for pediatric migraine patients to receive
CBT vs. conventional pharmacological therapy (which in a national trial reduced headache days similar to
placebo pill: AMI 52% of participants improved; Placebo 61%). Pilot data from our group demonstrate that:
CBT induces changes in brain connectivity/activation, and QST at baseline predicts reduced migraines at 8
weeks. These findings show proof of concept specific to pediatric migraine patients and refined the design of
this project, which will recruit 240 youth ages 10 to 17 with migraine to undergo functional MRI and QST before
and after 8 weeks of either CBT, placebo, or AMI to address these aims: Aim 1: Does CBT engage brain
mechanisms which are distinct from those engaged by pill-based therapy (placebo & AMI)? Aim 2: Are poorer
baseline pain modulatory mechanisms measured by QST predictive of greater headache day reduction from
CBT vs. pill-based therapy? Exploratory Aims: a. Assess whether brain changes at 8 weeks in those who
receive CBT play a mediational role when outcomes are assessed at a 3 month follow-up; b. Test if the
findings from Aims 1 and 2 are supported when other pain contextual variables (anxiety, depression, sleep) are
included in the statistical models; c. Compare neuroimaging between placebo and AMI; d. All analyses will
include age, sex, pubertal status, and brain structural connectivity in the statistical models to assess
developmental variables. Pediatric medical and behavioral clinicians can use mechanistic insights from
translational investigations such as this project to enhance the care they provide to youth with migraine.
项目总结:
项目成果
期刊论文数量(4)
专著数量(0)
科研奖励数量(0)
会议论文数量(0)
专利数量(0)
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Robert C Coghill其他文献
Robert C Coghill的其他文献
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{{ truncateString('Robert C Coghill', 18)}}的其他基金
Identifying neural pathophysiology in juvenile fibromyalgia
确定青少年纤维肌痛的神经病理生理学
- 批准号:
10242702 - 财政年份:2019
- 资助金额:
$ 60.31万 - 项目类别:
Dissecting Neural Mechanisms Supporting Mind and Body Approaches to Pain Reduction in Youth with Migraine
剖析支持青少年偏头痛减轻疼痛的身心方法的神经机制
- 批准号:
10370373 - 财政年份:2019
- 资助金额:
$ 60.31万 - 项目类别:
Identifying neural pathophysiology in juvenile fibromyalgia
确定青少年纤维肌痛的神经病理生理学
- 批准号:
10468863 - 财政年份:2019
- 资助金额:
$ 60.31万 - 项目类别:
Dissecting Neural Mechanisms Supporting Mind and Body Approaches to Pain Reduction in Youth with Migraine
剖析支持青少年偏头痛减轻疼痛的身心方法的神经机制
- 批准号:
9906854 - 财政年份:2019
- 资助金额:
$ 60.31万 - 项目类别:
Dissecting Neural Mechanisms Supporting Mind and Body Approaches to Pain Reduction in Youth with Migraine
剖析支持青少年偏头痛减轻疼痛的身心方法的神经机制
- 批准号:
10596090 - 财政年份:2019
- 资助金额:
$ 60.31万 - 项目类别:
Distinct Mechanisms of Cognitive Behavioral Therapy Effects in Youth with Migraine: Insights from Neuroimaging and Quantitative Sensory Testing (The How and Why Youth with Headaches Get Better Study)
认知行为治疗对偏头痛青少年的影响的独特机制:来自神经影像学和定量感官测试的见解(头痛青少年如何以及为何得到更好的研究)
- 批准号:
9902553 - 财政年份:2018
- 资助金额:
$ 60.31万 - 项目类别:
Brain Mechanisms Supporting Individual Differences in Pain
支持疼痛个体差异的大脑机制
- 批准号:
9258510 - 财政年份:2015
- 资助金额:
$ 60.31万 - 项目类别:
Brain Mechanisms Supporting Individual Differences in Pain
支持疼痛个体差异的大脑机制
- 批准号:
8818530 - 财政年份:2015
- 资助金额:
$ 60.31万 - 项目类别:
Brain Mechanisms Supporting the Modulation of Pain by Meditation and Placebo
支持通过冥想和安慰剂调节疼痛的大脑机制
- 批准号:
8284617 - 财政年份:2012
- 资助金额:
$ 60.31万 - 项目类别:
Brain Mechanisms Supporting the Modulation of Pain by Meditation and Placebo
支持通过冥想和安慰剂调节疼痛的大脑机制
- 批准号:
8528483 - 财政年份:2012
- 资助金额:
$ 60.31万 - 项目类别:
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