Control of Brain Activity and Chronic Back Pain via Real Time/S.Mackey

直到最近，人们还不清楚人们是否可以控制特定的神经过程来影响他们的行为。 相关的感知、认知和行为。利用实时功能磁共振成像（rtfMRI）神经反馈，我们最近 研究表明，健康受试者和慢性疼痛患者可以学会控制前额叶的活动， 扣带皮层，导致他们的疼痛显着和临床意义的减少。我们建议 将这一令人兴奋的发现扩展到慢性腰痛（CLBP）患者。 CLBP是一种高度流行且难以治疗的疾病，迫切需要新的治疗方法。虽然 CLBP的潜在机制还不清楚，基础科学已经揭示， 中枢疼痛调节和情绪调节系统起关键作用。与此同时， 临床文献表明身心疗法（MBTs）和认知/情绪调节的价值 治疗慢性疼痛的策略。目前尚不清楚的是，基础和临床科学发现 是联系在一起的，这样MBTs就改变了与疼痛有关的大脑系统的功能。本计画提出 使用rtfMRI神经反馈作为一种创新技术来操纵与疼痛相关的关键大脑系统， 然后将机制研究结果转化为慢性疼痛的最佳临床治疗方法。 我们将通过解决我们以前的rtfMRI研究中发现的三个问题来推进这一关键领域：（1） 因为患者采用不同的认知策略来调节大脑活动， 学习控制的有效性不同，（2）多个大脑区域在单个区域的过程中被激活和失活， 反馈控制，建议控制多个分布式区域可能比 控制一个单一的区域，和（3）显着的个体差异存在于如何以及患者可以调节 他们的大脑活动因此，我们的总体目标是：（1）描述CLBP患者的认知策略 最佳地控制单个和多个分布的大脑区域，和（2）确定由于疼痛缓解的介质 到rtfMRI。我们的总体目标是推进我们的身心疗法的科学知识，特别是 学习控制特定的神经过程如何导致慢性疼痛的减轻。

Until recently, it was unclear if people could attain control over specific neural processes to influence their associated perceptions, cognitions and behaviors. Using real-time fMRI (rtfMRI) neurofeedback, we recently demonstrated that healthy subjects and patients with chronic pain can learn to control activity in the anterior cingulate cortex, leading to significant and clinically meaningful reductions in their pain. We propose to extend this exciting finding to patients with chronic low back pain (CLBP). CLBP is a highly prevalent and difficult to treat condition with a pressing need for novel therapies. Although underlying mechanisms in CLBP are not well understood, basic science has revealed that abnormalities in central pain modulatory and emotion regulatory systems play a crucial role. At the same time, a robust clinical literature suggests the value of mind-body therapies (MBTs) and cognitive/emotion regulatory strategies in the management of chronic pain. What is not clear is how the basic and clinical science findings are linked, such that MBTs alter the functioning of the brain systems involved in pain. This project proposes to use rtfMRI neurofeedback as an innovative technique to manipulate key brain systems related to pain and then translate mechanistic findings to optimize clinical therapies for chronic pain. We will advance this critical area by resolving three issues identified in our previous rtfMRI studies: (1) because patients employ different cognitive strategies to modulate brain activity, their activated brain regions and efficacy in learned control vary, (2) multiple brain regions are activated and deactivated during singleregion feedback control, suggesting control of multiple, distributed regions may be more effective than control of a single region, and (3) significant individual differences exist in how well patients can modulate their brain activity. Therefore, our overall aims are to: (1) characterize CLBP patients' cognitive strategies for optimally controlling single and multiple distributed brain regions, and (2) identify mediators of pain relief due to rtfMRI. Our overall objective is to advance our scientific knowledge of mind-body therapies, specifically how learned control of specific neural processes leads to reduction in chronic pain.