Locus of Pain Control: Neural Substrates & Modifiability

描述：相信自己有能力通过个人努力控制疼痛与更好的疼痛管理、更高的功能状态和更好的长期坚持治疗方案有关。随着时间的推移，纤维肌痛综合征（FMS）患者对疼痛控制的信念似乎较低且稳定，但最近的文献和我们自己的试点调查表明，这些信念可能通过行为干预而具有可塑性。从理论上讲，任何信念的改变都需要以经历新的个人控制为前提；因此，在这种信念改变之前，患者必须真正经历成功的个人疼痛控制。与此相关，我们利用功能性磁共振成像（fMRI）获得的试点数据表明，FMS患者在负责疼痛体验的大脑皮质区域中，具有强烈的内部和外部疼痛控制位点的疼痛刺激处理方式不同。到目前为止，还没有临床研究专门关注疼痛控制的信念作为治疗目标，也没有研究寻求最节俭的行为方法来改变这些信念。同样，到目前为止，还没有研究探索改变对疼痛控制的信念是否会改变中枢疼痛处理。采用随机对照设计，本研究旨在测试两种单模式非药物方法的有效性，以改变FMS患者对个人疼痛控制的信念：处方有氧健身和放松训练。这些干预措施将与标准护理控制条件进行比较。根据以前的文献，这两种干预措施应该提供一个成功经验的基础，可归因于个人努力，这将有助于改变对疼痛控制的信念。我们假设这两种干预措施将优于标准护理控制条件。此外，我们打算证实和扩展我们的试点fMRI成像发现，表明不同的神经网络被不同的疼痛控制位点的个体所使用，然后证明，通过治疗，改变他们的控制点的个体也会改变他们的中枢疼痛处理的fMRI模式。这些发现将增加对高阶疼痛处理中情感和认知参与的新信息，并开始解释改变控制信念的非药物干预的有效性所涉及的机制。

DESCRIPTION: Belief in ones ability to control pain through personal effort is associated with better pain management, higher functional status, and better long-term adherence to treatment regimens. While beliefs in pain control appear to be low and stable over time in patients with Fibromyalgia Syndrome (FMS), recent literature and our own pilot investigations suggest that these beliefs may be malleable through behavioral interventions. Theoretically, any change in belief will need to be predicated upon experiencing newfound personal control; thus patients must actually experience successful personal pain control before such beliefs can change. Relatedly, we possess pilot data using functional MRI (fMRI) suggesting that patients with FMS who espouse a strong internal versus external locus of pain control process painful stimuli differently in the cortical brain regions responsible for the experience of pain. To date no clinical studies have specifically focused on beliefs in pain control as a target of treatment nor have studies been conducted that seek the most parsimonious behavioral approach for modifying these beliefs. Similarly, no studies to date have explored whether changing beliefs in pain control will alter central pain processing. Using a randomized controlled design, the proposed study seeks to test the effectiveness of two single modality non-pharmacological methods for modifying beliefs in personal pain control in patients with FMS: prescribed aerobic fitness, and relaxation training. These interventions will be compared to a standard care control condition. Based upon previous literature, both of these interventions should provide a foundation of success experiences attributable to personal effort that would facilitate changing beliefs in pain control. We posit that both interventions will be superior to a standard care only control condition. Moreover, we intend to confirm and extend our pilot fMRI imaging findings suggesting that different neural networks are used by individuals with varying loci of pain control, and then demonstrate that individuals who, through therapy, change their locus of control also have changes in their fMRI patterns of central pain processing. These findings will add to the emerging information on affective and cognitive involvement in higher order pain processing and begin to explain the mechanisms involved in the effectiveness of non-pharmacological interventions that modify beliefs about control.