Locus of Pain Control: Neural Substrates & Modifiability

描述：相信一个人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。虽然纤维肌痛综合征(FMS)患者对疼痛控制的信念随着时间的推移似乎很低和稳定，但最近的文献和我们自己的试点调查表明，通过行为干预，这些信念可能是可塑性的。从理论上讲，信念的任何改变都需要建立在经历新的个人控制的基础上；因此，在这种信念改变之前，患者必须真正体验到成功的个人疼痛控制。与之相关的是，我们拥有使用功能磁共振成像(FMRI)的试点数据，这表明支持强烈的内部和外部疼痛控制中心的FMS患者，在负责疼痛体验的大脑皮质区域处理疼痛刺激的方式不同。到目前为止，还没有临床研究特别关注将疼痛控制作为治疗目标的信念，也没有进行过寻求最节俭的行为方法来改变这些信念的研究。同样，到目前为止还没有研究探索疼痛控制信念的改变是否会改变中枢疼痛处理。使用随机对照设计，这项拟议的研究试图测试两种单通道非药物方法改变FMS患者个人疼痛控制信念的有效性：规定的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，这两种干预措施都应该提供归因于个人努力的成功经验的基础，这将有助于改变对疼痛控制的信念。我们假设，这两种干预措施都优于标准的纯护理对照条件。此外，我们打算证实和扩展我们的试点fMRI成像发现，即具有不同疼痛控制点的个体使用不同的神经网络，然后证明通过治疗改变其控制点的个体也改变了其中枢疼痛处理的fMRI模式。这些发现将增加关于情感和认知参与高级疼痛处理的新兴信息，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.