Pain-related Brain Mechanisms for Pain Catastrophizing Behavior in Response to Home-based Mindfulness-based Meditation Paired with Transcranial Direct Current Stimulation

家庭正念冥想与经颅直流电刺激对疼痛灾难性行为的疼痛相关大脑机制

• 批准号: 10665161
• 负责人: Hyochol Ahn
• 金额: $ 48.5万
• 依托单位: FLORIDA STATE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-01 至 2025-01-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10665161
• 关键词: Adult; Amygdaloid structure; Behavior; Behavioral; Biological Models; Brain; Brain imaging; Brain region; Cerebrovascular Circulation; Clinical Trials; Data; Degenerative polyarthritis; Development; Double-Blind Method; Elderly; Functional Magnetic Resonance Imaging; Future; Goals; Health; Home; Image; Insula of Reil; Intervention; Knee Osteoarthritis; Literature; Meditation; Modeling; Numeric Rating Scale; Outcome; Pain; Pain management; Parents; Participant; Patients; Persons; Phase; Pilot Projects; Process; Randomized; Research; Rest; Supervision; Testing; Thalamic structure; Therapeutic Effect; Translating; United States; arm; base; behavior change; behavioral/social science; chronic pain; clinical pain; design; improved; midbrain central gray substance; mindfulness; neuroregulation; osteoarthritis pain; pain catastrophizing; pain model; pain symptom; parent project; putamen; recruit; response

ABSTRACT The long-term goal of this mechanism of action-focused supplement project is to develop a comprehensive understanding of how patients exert neural control over pain-related behaviors, leading to reductions in clinical pain and improved health outcomes for older adults using home-based nonpharmacological pain management approaches. Based on a behavioral activation and inhibition systems model of pain that explains pain-related behavior, this supplement will assess underlying brain mechanisms explaining pain catastrophizing behavior change following home-based nonpharmacological pain interventions in older adults with knee osteoarthritis (OA). Currently more than 14 million adults in the United States are living with symptomatic OA, one of the leading causes of chronic pain. In the parent study (R01NR019051), we are conducting a double-blind, randomized, sham-controlled phase II parallel group (1:1:1:1 for four groups defined by 2x2 factorial design) clinical trial to determine the effects of remotely supervised Mindfulness-based Meditation (MBM) paired with Transcranial Direct Current Stimulation (tDCS) at home on clinical pain and symptoms in older adults with symptomatic knee OA. The parent study did not originally posit a mechanistic clinical trial, and this supplemental study will provide invaluable mechanistic brain imaging data for pain-related behavior change building on our parent study. Recently, literatures showed that clinical pain is associated with pain catastrophizing behavior and that functional magnetic resonance imaging (fMRI) imaging responses suggested greater maladaptive changes in pain-related brain function in patients with knee OA (e.g., greater changes in resting and pain-evoked cerebral blood flow in cingulate, insula, thalamus, amygdala, periaqueductal gray, and putamen). Taken together, in this supplement study, we will collect pain catastrophizing behavior and fMRI data among 40 older adults with knee OA who will be recruited in the subsequent year in the parent study using the parent project’s existing design and recruitment plan. The central hypothesis is that home-based MBM paired with tDCS will decrease maladaptive changes in pain-related brain function, which will predict pain catastrophizing behavior and clinical pain. This hypothesis will be tested by pursuing the following specific aims: To evaluate the effects of MBM paired with tDCS on pain-related brain function (quantified by fMRI data) in older adults with knee OA (specific aim 1); and to evaluate the relationship between pain-related brain function (quantified by fMRI data) and pain catastrophizing behavior and OA-related clinical pain (specific aim 2). The proposed research is significant because this supplement study is expected to reveal underexplored causal processes (i.e., pain-related brain function via functional connectivity alterations) that can illuminate the intervention’s mechanisms of actions.

抽象的 这种以动作为中心的补充项目的长期目标是开发一个全面的 了解患者如何对与疼痛相关的行为产生神经控制，从而减少临床 使用基于家庭的非药物疼痛管理的老年人的疼痛和改善的健康结果 方法。基于行为激活和抑制系统的疼痛模型，该模型解释了与疼痛有关的 行为，这种补充剂将评估解释疼痛灾难性行为的潜在大脑机制 膝盖骨关节炎的老年人的家庭非药物疼痛干预措施后改变之后的变化 （OA）。目前，美国有超过1400万成年人患有症状性OA，其中之一 慢性疼痛的主要原因。在家长研究（R01NR019051）中，我们进行了双盲 随机，假对照的II期并行组（1：1：1：1：1：由2x2阶乘设计定义的四组） 临床试验以确定远程监督基于正念的冥想（MBM）的影响 家庭临床疼痛和老年人的临床疼痛和症状的经颅直流刺激（TDC） 有症状的膝盖OA。家长研究最初并不是一项机械临床试验的阳性，这 补充研究将为疼痛相关的行为变化提供宝贵的机械脑成像数据 基于我们的父母研究。最近，文献表明临床疼痛与疼痛有关 灾难性的行为和功能磁共振成像（fMRI）成像响应建议 膝关节OA患者的疼痛相关脑功能的不良适应不良变化（例如，更大的变化 扣带回，岛状，丘脑，杏仁核，周围灰色的静止和疼痛诱发的脑血流 putamen）。综上所述，在这项补充研究中，我们将收集疼痛的灾难性行为和fMRI 在父母研究中将招募的40名患有膝盖OA的老年人的数据 使用父项目的现有设计和招聘计划。中心假设是基于家庭的 与TDC配对的MBM将减少与疼痛相关的大脑功能的适应不良的变化，这将预测疼痛 灾难性的行为和临床疼痛。该假设将通过追求以下特定的特定来检验 目的：评估与TDC配对的MBM对疼痛相关脑功能的影响（通过fMRI数据量化） 在膝盖OA的老年人中（特定目标1）；并评估与疼痛相关的大脑之间的关系 功能（通过fMRI数据量化）和疼痛灾难性的行为和与OA相关的临床疼痛（特定目的 2）。拟议的研究很重要，因为这项补充研究有望揭示未置换的 因果过程（即通过功能连通性改变与疼痛相关的大脑功能），可以照亮该 干预的行动机制。