Using fMRI to understand response to an integrative treatment for pain and anxiety in pediatric functional abdominal pain disorders (FAPD)

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Project Summary The candidate’s long-term objectives are to devise effective and mechanistically-informed nonpharmacological interventions for pediatric functional abdominal pain disorders (FAPD). The candidate’s pilot studies have shown that increased anxiety in FAPD is associated with greater pain and disability, and anxiety adversely impacts response to standard cognitive behavioral therapy (CBT) for pain. Thus, the candidate developed the Aim to Decrease Anxiety and Pain Treatment (ADAPT; F32 HD078049), a promising intervention for the management of pain and anxiety in pediatric FAPD. Complementary approaches, such as mindfulness meditation, may further reduce pain and anxiety. In this proposal, the PI integrates mindfulness meditation with conventional approaches in the ADAPT protocol to further improve patient outcomes. In addition to developing effective integrative treatments, the candidate aims to understand the mechanisms of treatment effects. For the proposed study, the candidate will investigate brain mechanisms that are implicated in response to an integrative intervention for pediatric FAPD. Patients with FAPD and comorbid anxiety will undergo an fMRI to explore differences in response to visceral pain induction (via the water load symptom provocation task; WL-SPT) after ADAPT as compared to a waitlist control condition. In Aim 1, it is proposed that youth will show reduced hyperconnectivity between the amygdala and prefrontal cortex during the WL-SPT following ADAPT. In Aim 2, brain activations associated with a subjective response to pain induction are expected to diminish in youth who have completed ADAPT. Conventional blood oxygenation level dependent (BOLD) fMRI will be used to assess functional connectivity to capture moment-to-moment fluctuations in activity. The arterial spin label MRI technique will be used to gain inferences into regional brain activity since these activations represent a relatively steady-state. In line with the NCCIH funding priorities, this study seeks to increase understanding of the mechanisms through which nonpharmacological treatment approaches impact clinical outcomes in chronic pain and anxiety. Results will advance the field by providing crucial information needed for the refinement and testing of a tailored intervention for FAPD and comorbid anxiety - the candidate’s long-term career goal. In this proposal, the candidate will draw upon training and expertise in pediatric chronic pain and anxiety to investigate brain mechanisms of treatment response in pediatric FAPD under the guidance of a strong mentorship team. To successfully execute this research and prepare for an independent research career, the candidate will undergo extensive training in 1) complementary treatments for chronic pain and anxiety with a focus on mindfulness meditation, 2) functional brain imaging, and 3) advanced statistics. This proposal will enable the candidate to develop a sophisticated understanding of the mechanisms of treatment response in FAPD and develop a unique program of research. Results will allow the candidate to test tailored nonpharmacological interventions in youth with chronic pain as an integrative medicine researcher.