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

描述（由申请人提供）：儿科慢性疼痛是一个严重的国家健康问题，导致医疗保健利用率很高。与慢性疼痛相关的生理和心理后果影响整体健康，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是必不可少的，因为心理社会过程与生理过程相互作用，影响疼痛的结果。拟议的研究利用神经成像（fMRI）和心理生理学技术，以提高我们对这些关系的理解。疼痛相关的恐惧，与维持疼痛相关的残疾的一个重要的结构，是在目前的研究建议的重点心理社会过程。该K23奖的长期目标是候选人建立一个以患者为导向的研究计划，以整合行为和神经成像技术。其目的是了解恐惧的神经机制和相关的负面影响与维持疼痛相关的残疾青年慢性疼痛;最终表征机制的变化和治疗反应的心理干预，针对儿童慢性疼痛。选择复杂区域疼痛综合征（CRPS）作为模型条件，因为高比例的CRPS患者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，用于未来的研究。候选人将通过以下方式实现这一目标：1）在临床/研究环境中的指导，2）由候选人的赞助商和共同赞助商进行fMRI实践培训，并辅之以fMRI和高级统计学的教学法，以及3）执行拟议的研究计划。研究1评估了一组患有CRPS的儿童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检查急性和长期的变化，激活杏仁核和相关领域在一个队列的CRPS患者的高度恐惧成像在入院，出院，和6个月后，密集的疼痛康复计划，以前避免和害怕的活动面临。这些研究将为未来的神经研究奠定基础，研究儿童慢性疼痛以及恐惧和相关负面影响的影响。公共卫生相关性：复发性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的神经基础和相关的负面影响可以为未来的治疗提供信息，以减轻他们的痛苦，使其成为实证研究的关键领域。 公共卫生相关性：复发性慢性疼痛可影响多达四分之一的儿童，并可持续至成年。了解儿童持续性疼痛的神经基础和相关的负面影响可以为未来的治疗提供信息，以减轻他们的痛苦，使其成为实证研究的关键领域。

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.