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

描述(申请人提供)：儿科慢性疼痛是一个严重的国家健康问题，导致高水平的医疗保健利用。与慢性疼痛相关的生理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脑-行为关系是至关重要的，因为心理社会过程与生理过程相互作用，从而影响疼痛结果。这项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。疼痛相关恐惧是与维持疼痛相关残疾相关的一个基本概念，是当前研究提案中关注的心理社会过程。这一K23奖项的长期目标是为候选人建立一条以患者为导向的研究方案线，以整合行为和神经成像技术。其目的是了解与慢性疼痛青少年疼痛相关残疾的维持有关的恐惧和相关负面情绪的神经机制；最终确定针对慢性疼痛儿童的心理干预的改变和治疗反应的机制。复杂区域疼痛综合征(CRPS)被选为模型条件，因为CRPS患者经历持续疼痛相关恐惧的比例很高。主要的培训目标是获得使用功能磁共振成像的专门知识，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)候选人的赞助商和共同赞助商在功能磁共振成像方面的实践培训，辅之以功能磁共振成像和高级统计学的教学；以及3)执行拟议的研究计划。研究1评估了一组患有CRPS的儿科疼痛患者杏仁核及相关区域的激活与疼痛恐惧的关系。研究2检查了一组CRPS患者在入院、出院和强化疼痛康复计划六个月后的图像中杏仁核及相关区域激活的急性和长期变化，在这些患者中，以前避免和恐惧的活动将面临挑战。这些研究将为未来的神经研究奠定基础，以检查儿科慢性疼痛以及恐惧和相关负面情绪的影响。公共卫生相关性：反复发作的慢性疼痛可影响多达四分之一的儿童，并可持续到成年。了解儿童持续性疼痛及其相关负面情绪的神经基础可以为未来的治疗提供信息，以减轻他们的痛苦，使其成为经验性研究的关键领域。 公共卫生相关性：反复发作的慢性疼痛可影响多达四分之一的儿童，并可持续到成年。了解儿童持续性疼痛及其相关负面情绪的神经基础可以为未来的治疗提供信息，以减轻他们的痛苦，使其成为经验性研究的关键领域。

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.