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

使用功能磁共振成像了解小儿功能性腹痛疾病 (FAPD) 疼痛和焦虑综合治疗的反应

• 批准号: 10322676
• 负责人: Natoshia Raishevich Cunningham
• 金额: $ 13.04万
• 依托单位: MICHIGAN STATE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-01-01 至 2024-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10322676
• 关键词: Abdominal Pain; Address; Adolescent; Adult; Affect; Affective; Amygdaloid structure; Anterior; Anxiety; Area; Arousal; Award; Awareness; Brain; Brain imaging; Caring; Child; Childhood; Clinical; Cognitive; Cognitive Therapy; Compassion; Complementary therapies; Complex; Coping Skills; Development; Emotional; Environment; Foundations; Functional Magnetic Resonance Imaging; Funding; Future; Gastroenterology; Goals; Hypnosis; Insula of Reil; Integrative Medicine; Integrative Therapy; Intervention; Judgment; Left; Magnetic Resonance Imaging; Medical; Mentorship; Methods; Mind-Body Intervention; Motor; National Center for Complementary and Integrative Health; Neurosciences; Outcome; Pain; Pain Disorder; Pain Management Method; Pain Nature; Pain intensity; Pain management; Patient Self-Report; Patient-Focused Outcomes; Patients; Pilot Projects; Population; Prefrontal Cortex; Prevalence; Procedures; Process; Recurrent pain; Relaxation; Research; Research Personnel; Role; Schools; Signal Transduction; Somatosensory Cortex; Standardization; Stress; Symptoms; Techniques; Testing; Thalamic structure; Thinking; Training; Treatment Protocols; Visceral; Visceral Afferents; Visceral pain; Visit; Waiting Lists; Water; Youth; anxiety management; anxiety treatment; arterial spin labeling; blood oxygen level dependent; bodily sensation; career; chronic pain; chronic pain management; chronic painful condition; cingulate cortex; clinical anxiety; comorbidity; connectome; disability; experience; improved; mindfulness; mindfulness meditation; minimally invasive; multidisciplinary; neuroimaging; neuromechanism; pain reduction; programs; psychologic; response; sensory cortex; skills; social; statistics; targeted treatment; treatment comparison; treatment effect; treatment response

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.

项目概要 候选人的长期目标是为小儿功能性腹痛疾病（FAPD）设计有效且有机制信息的非药物干预措施。该候选人的试点研究表明，FAPD 患者的焦虑增加与更大的疼痛和残疾相关，并且焦虑会对标准疼痛认知行为疗法 (CBT) 的反应产生不利影响。 因此，候选人开发了减少焦虑和疼痛治疗的目标（ADAPT；F32 HD078049），这是一种治疗儿科 FAPD 疼痛和焦虑的有前途的干预措施。 补充方法，例如正念冥想，可以进一步减轻疼痛和焦虑。 在此提案中，PI 将正念冥想与 ADAPT 协议中的传统方法相结合，以进一步改善患者的治疗效果。除了开发有效的综合治疗之外，候选人还旨在了解治疗效果的机制。在拟议的研究中，候选人将研究与儿科 FAPD 综合干预反应有关的大脑机制。患有 FAPD 和共病焦虑的患者将接受功能磁共振成像 (fMRI)，以探讨 ADAPT 后与候补对照条件相比对内脏疼痛诱导（通过水负荷症状激发任务；WL-SPT）的反应差异。 在目标 1 中，建议青少年在 ADAPT 后的 WL-SPT 期间，杏仁核和前额皮质之间的超连接性会降低。 在目标 2 中，完成 ADAPT 的青少年中，与疼痛诱发的主观反应相关的大脑激活预计会减少。传统的血氧水平依赖 (BOLD) 功能磁共振成像将用于评估功能连接性，以捕获活动的瞬间波动。动脉自旋标记 MRI 技术将用于推断区域大脑活动，因为这些激活代表相对稳定的状态。根据 NCCIH 的资助重点，本研究旨在加深对非药物治疗方法影响慢性疼痛和焦虑临床结果的机制的了解。研究结果将提供完善和测试针对 FAPD 和共病焦虑（候选人的长期职业目标）的定制干预措施所需的关键信息，从而推动该领域的发展。在本提案中，候选人将利用儿科慢性疼痛和焦虑方面的培训和专业知识，在强大的指导团队的指导下研究儿科 FAPD 治疗反应的大脑机制。为了成功执行这项研究并为独立研究生涯做好准备，候选人将接受以下方面的广泛培训：1）慢性疼痛和焦虑的补充治疗，重点是正念冥想，2）功能性脑成像，3）高级统计。该提案将使候选人能够深入了解 FAPD 的治疗反应机制，并制定独特的研究计划。结果将使候选人能够作为综合医学研究人员测试针对患有慢性疼痛的青少年的定制非药物干预措施。

项目成果

Amygdalar functional connectivity during resting and evoked pain in youth with functional abdominal pain disorders.

• DOI: 10.1097/j.pain.0000000000002601
• 发表时间: 2022-10-01
• 期刊: Pain
• 影响因子: 7.4

Engagement during a Mixed In-Person and Remotely Delivered Psychological Intervention for Youth with Functional Abdominal Pain Disorders and Anxiety.

与功能性腹部疼痛和焦虑的年轻人进行混合的人间和遥不可及的心理干预。

• DOI: 10.3390/children8090775
• 发表时间: 2021-09-02
• 期刊: Children (Basel, Switzerland)
• 作者: Miller AK;Ely SL;Barber Garcia BN;Richardson P;Cunningham NR
• 通讯作者: Cunningham NR

Non-pharmacologic therapies in treatment of childhood-onset systemic lupus erythematosus: A systematic review.

• DOI: 10.1177/09612033221094704
• 发表时间: 2022-06
• 期刊: LUPUS
• 影响因子: 2.6
• 作者: Ross, Elizabeth;Abulaban, Khalid;Kessler, Elizabeth;Cunningham, Natoshia
• 通讯作者: Cunningham, Natoshia

The Impact of Posttraumatic Stress Disorder on Clinical Presentation and Psychosocial Treatment Response in Youth with Functional Abdominal Pain Disorders: An Exploratory Study.

创伤后应激障碍对患有功能性腹痛疾病的青少年的临床表现和心理社会治疗反应的影响：一项探索性研究。

• DOI: 10.3390/children7060056
• 发表时间: 2020
• 期刊: Children (Basel, Switzerland)
• 作者: Nelson,Sarah;Cunningham,Natoshia
• 通讯作者: Cunningham,Natoshia

Cognitive Behavior Therapy Tailored to Anxiety Symptoms Improves Pediatric Functional Abdominal Pain Outcomes: A Randomized Clinical Trial.

• DOI: 10.1016/j.jpeds.2020.10.060
• 发表时间: 2021-03
• 期刊: The Journal of pediatrics
• 作者: Cunningham NR;Kalomiris A;Peugh J;Farrell M;Pentiuk S;Mallon D;Le C;Moorman E;Fussner L;Dutta RA;Kashikar-Zuck S
• 通讯作者: Kashikar-Zuck S