Stanford CAM Center for Chronic Back Pain

描述（由申请人提供）：直到最近，人们还不清楚人们是否能够控制特定的神经过程来影响他们相关的感知、认知和行为。利用实时功能磁共振成像（rtfMRI）神经反馈，我们最近证明了健康受试者和慢性疼痛患者可以学会控制前扣带皮层的活动，从而显著减少临床意义上的疼痛。我们建议将这一令人兴奋的发现扩展到慢性腰痛（CLBP）患者。CLBP是一种非常普遍且难以治疗的疾病，迫切需要新的治疗方法。尽管CLBP的潜在机制尚不清楚，但基础科学表明，中枢疼痛调节和情绪调节系统的异常在CLBP中起着至关重要的作用。与此同时，大量的临床文献表明身心疗法（mbt）和认知/情绪调节策略在慢性疼痛治疗中的价值。目前尚不清楚的是，基础科学和临床科学的发现是如何联系在一起的，比如mbt改变了与疼痛有关的大脑系统的功能。本项目提出使用rtfMRI神经反馈作为一种创新技术来操纵与疼痛相关的关键大脑系统，然后将机制发现转化为优化慢性疼痛的临床治疗方法。我们将通过解决我们之前的rtfMRI研究中确定的三个问题来推进这一关键领域：(1)由于患者采用不同的认知策略来调节大脑活动，其激活的大脑区域和学习控制的效果存在差异；(2)在单区域反馈控制中，多个大脑区域被激活和失活，表明控制多个分布区域可能比控制单个区域更有效；(3)患者调节大脑活动的效果存在显著的个体差异。因此，我们的总体目标是：(1)表征CLBP患者最佳控制单个和多个分布式脑区域的认知策略；(2)通过rtfMRI识别疼痛缓解介质。我们的总体目标是推进身心疗法的科学知识，特别是学习控制特定神经过程如何减少慢性疼痛。

DESCRIPTION (provided by applicant): Until recently, it was unclear if people could attain control over specific neural processes to influence their associated perceptions, cognitions and behaviors. Using real-time fMRI (rtfMRI) neurofeedback, we recently demonstrated that healthy subjects and patients with chronic pain can learn to control activity in the anterior cingulate cortex, leading to significant and clinically meaningful reductions in their pain. We propose to extend this exciting finding to patients with chronic low back pain (CLBP). CLBP is a highly prevalent and difficult to treat condition with a pressing need for novel therapies. Although underlying mechanisms in CLBP are not well understood, basic science has revealed that abnormalities in central pain modulatory and emotion regulatory systems play a crucial role. At the same time, a robust clinical literature suggests the value of mind-body therapies (MBTs) and cognitive/emotion regulatory strategies in the management of chronic pain. What is not clear is how the basic and clinical science findings are linked, such that MBTs alter the functioning of the brain systems involved in pain. This project proposes to use rtfMRI neurofeedback as an innovative technique to manipulate key brain systems related to pain and then translate mechanistic findings to optimize clinical therapies for chronic pain. We will advance this critical area by resolving three issues identified in our previous rtfMRI studies: (1) because patients employ different cognitive strategies to modulate brain activity, their activated brain regions and efficacy in learned control vary, (2) multiple brain regions are activated and deactivated during single region feedback control, suggesting control of multiple, distributed regions may be more effective than control of a single region, and (3) significant individual differences exist in how well patients can modulate their brain activity. Therefore, our overall aims are to: (1) characterize CLBP patients' cognitive strategies for optimally controlling single and multiple distributed brain regions, and (2) identify mediators of pain relief due to rtfMRI. Our overall objective is to advance our scientific knowledge of mind-body therapies, specifically how learned control of specific neural processes leads to reduction in chronic pain.