A neuroimaging perspective of pain-related fear in children with chronic pain

慢性疼痛儿童疼痛相关恐惧的神经影像学视角

• 批准号: 8026767
• 负责人: LAURA E SIMONS
• 金额: $ 11.62万
• 依托单位: BOSTON CHILDREN'S HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-03-01 至 2016-02-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8026767
• 关键词: Acute; Acute Pain; Address; Admission activity; Adult; Affect; Affective; Amygdaloid structure; Area; Behavioral; Brain; Child; Childhood; Clinical; Clinical Research; Complement; Complex Regional Pain Syndromes; Data; Data Analyses; Development; Elements; Emotional; Environment; Exhibits; Extinction (Psychology); Fright; Functional Magnetic Resonance Imaging; Future; Goals; Health; Human; Image; Individual Differences; Intervention; Investigation; Link; Liquid substance; Maintenance; Measures; Mentored Patient-Oriented Research Career Development Award; Mentorship; Modeling; Neural Pathways; Neuronal Plasticity; Outcome; Pain; Patients; Perception; Persistent pain; Physiological; Physiological Processes; Process; Protocols documentation; Psychophysiology; Recurrence; Rehabilitation therapy; Reporting; Research; Research Proposals; Role; Signal Transduction; Stimulus; Stress; Study Section; Symptoms; System; Techniques; Training; Work; Youth; base; brain behavior; chronic pain; classical conditioning; cohort; conditioned fear; disability; experience; follow-up; health care service utilization; innovation; neglect; neural circuit; neuroimaging; neuromechanism; patient oriented research; programs; psychologic; psychological distress; psychosocial; public health relevance; relating to nervous system; response; statistics; treatment response

DESCRIPTION (provided by applicant): Pediatric chronic pain is a critical national health problem resulting in high levels of healthcare utilization. The physical and psychological consequences associated with chronic pain impact overall health and can predispose the development of adult chronic pain. Examining brain-behavior relations among children with chronic pain is essential as psychosocial processes reciprocally interact with physiologic processes to influence pain outcomes. The proposed research utilizes neuroimaging (fMRI) and psychophysiological techniques to enhance our understanding of these relations. Pain-related fear, an essential construct associated with the maintenance of pain-related disability, is the psychosocial process of focus in the current research proposal. The long-term goal of this K23 award is for the candidate to establish a programmatic line of patient-oriented research to integrate behavioral and neuroimaging techniques. The intent is to understand the neural mechanisms of fear and associated negative affect associated with the maintenance of pain-related disability among youth with chronic pain; ultimately characterizing mechanisms of change and treatment responses to psychological interventions targeting children with chronic pain. Complex Regional Pain Syndrome (CRPS) was chosen as a model condition, as a high proportion of patients with CRPS experience persistent pain-related fear. The primary training objective is to acquire expertise in the use of fMRI for use in future studies. The candidate will accomplish this through: 1) mentorship in a clinical/research environment, 2) hands-on training in fMRI by the candidate's sponsor and co-sponsors complemented by didactics in fMRI and advanced statistics, and 3) execution of the proposed research plan. Study 1 assesses activation of the amygdala and related areas in association with fear of pain in a cohort of pediatric pain patients with CRPS. Study 2 examines acute and long-term changes in activation of the amygdala and related areas in a cohort of CRPS patients with high fear imaged at admission, discharge, and six months after an intensive pain rehabilitation program where previously avoided and feared activities are confronted. These studies will lay the groundwork for future neural investigations examining pediatric chronic pain and the impact of fear and associated negative affect. Public Health Relevance: Recurrent, chronic pain can affect up to a quarter of children and can persist into adulthood. Understanding the neural underpinnings of persistent pain and associated negative affect among children can inform future treatments to ameliorate their suffering, making it a critical area of empirical investigation. PUBLIC HEALTH RELEVANCE: Recurrent, chronic pain can affect up to a quarter of children and can persist into adulthood. Understanding the neural underpinnings of persistent pain and associated negative affect among children can inform future treatments to ameliorate their suffering, making it a critical area of empirical investigation.

描述（由申请人提供）：小儿慢性疼痛是一个严重的国家健康问题，导致医疗保健利用率很高。与慢性疼痛相关的身体和心理后果会影响整体健康，并可能导致成人慢性疼痛的发展。检查慢性疼痛儿童的大脑行为关系至关重要，因为心理社会过程与生理过程相互作用，影响疼痛结果。拟议的研究利用神经成像（fMRI）和心理生理学技术来增强我们对这些关系的理解。与疼痛相关的恐惧是与维持与疼痛相关的残疾相关的基本结构，是当前研究提案中重点关注的心理社会过程。该 K23 奖项的长期目标是让候选人建立一条以患者为导向的研究计划线，以整合行为和神经影像技术。目的是了解患有慢性疼痛的青少年中恐惧的神经机制以及与疼痛相关残疾的维持相关的相关负面影响；最终描述针对慢性疼痛儿童的心理干预的变化机制和治疗反应。复杂区域疼痛综合征 (CRPS) 被选为模型病症，因为大部分 CRPS 患者都会经历持续的疼痛相关恐惧。主要培训目标是获得使用功能磁共振成像的专业知识，以便在未来的研究中使用。候选人将通过以下方式实现这一目标：1) 临床/研究环境中的指导，2) 由候选人的申办者和共同申办者进行的 fMRI 实践培训，并辅以 fMRI 和高级统计方面的教学，以及 3) 执行拟议的研究计划。研究 1 评估了一组患有 CRPS 的儿科疼痛患者中杏仁核和相关区域的激活与疼痛恐惧的关系。研究 2 检查了一组患有高度恐惧的 CRPS 患者的杏仁核和相关区域激活的急性和长期变化，这些患者在入院、出院以及接受强化疼痛康复计划后六个月进行成像，这些患者之前避免和害怕的活动发生了。这些研究将为未来检查儿科慢性疼痛以及恐惧和相关负面影响的影响的神经研究奠定基础。公共卫生相关性：复发性慢性疼痛可能影响多达四分之一的儿童，并可能持续到成年。了解儿童持续疼痛和相关负面影响的神经基础可以为未来减轻痛苦的治疗提供信息，使其成为实证研究的关键领域。 公共卫生相关性：复发性慢性疼痛可能影响多达四分之一的儿童，并可能持续到成年。了解儿童持续疼痛和相关负面影响的神经基础可以为未来减轻痛苦的治疗提供信息，使其成为实证研究的关键领域。