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

描述（由申请人提供）：儿童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影响整体健康，并可诱发成人慢性疼痛的发展。研究慢性疼痛儿童的脑行为关系是必要的，因为心理社会过程与生理过程相互作用，影响疼痛结果。本研究利用神经成像（fMRI）和心理生理学技术来增强我们对这些关系的理解。疼痛相关恐惧是与疼痛相关残障维持相关的重要构念，是当前研究的重点。该K23奖的长期目标是为候选人建立一个以患者为导向的研究计划线，以整合行为和神经成像技术。目的了解青少年慢性疼痛患者的恐惧及相关负性情绪与疼痛相关残疾维持的神经机制；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，因为有很高比例的CRPS患者经历持续的疼痛相关恐惧。主要训练目标是获得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完成：1)在临床/研究环境中接受指导；2)由候选人的赞助者和共同赞助者进行功能磁共振成像的实践培训，并辅以功能磁共振成像和高级统计学的教学；3)执行拟议的研究计划。研究1评估了一组患有CRPS的儿童疼痛患者的杏仁核和相关区域的激活与疼痛恐惧的关联。研究2检查了一组CRPS患者的杏仁核和相关区域的激活的急性和长期变化，这些患者在入院、出院时和接受强化疼痛康复计划6个月后都有高恐惧成像，这些患者以前避免和害怕的活动被面对。这些研究将为未来小儿慢性疼痛、恐惧和相关负面影响的神经研究奠定基础。公共卫生相关性：复发性慢性疼痛可影响多达四分之一的儿童，并可持续到成年。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.