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: 10023597
• 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 2022-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10023597
• 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; 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; Spin Labels; Standardization; Stress; Structure; Symptoms; Techniques; Testing; Thalamic structure; Thinking; Training; Treatment Protocols; Visceral; Visceral Afferents; Visceral pain; Visit; Waiting Lists; Water; Youth; anxiety management; anxiety treatment; blood oxygen level dependent; bodily sensation; career; chronic pain; 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.

项目摘要 候选人的长期目标是为儿科功能性腹痛疾病（FAPD）设计有效的和机械的非药物干预措施。候选人的试点研究表明，FAPD中焦虑的增加与更大的疼痛和残疾有关，焦虑对疼痛的标准认知行为疗法（CBT）的反应产生不利影响。 因此，候选人开发了旨在减少焦虑和疼痛治疗（ADAPT; F32 HD 078049），这是一种有希望的儿科FAPD疼痛和焦虑管理干预措施。 补充方法，如正念冥想，可以进一步减少疼痛和焦虑。 在该提案中，PI将正念冥想与ADAPT方案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方法外，候选人还旨在了解治疗效果的机制。对于拟议的研究，候选人将研究与儿科FAPD综合干预相关的大脑机制。患有FAPD和共病焦虑的患者将接受fMRI，以探索ADAPT后与等待列表对照条件相比，对内脏疼痛诱导（通过水负荷症状激发任务; WL-SPT）反应的差异。 在目标1中，有人提出，青年将显示减少杏仁核和前额叶皮层之间的超连接在WL-SPT ADAPT后。 在目标2中，与疼痛诱导的主观反应相关的大脑激活预计将在完成ADAPT的青少年中减少。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，以捕捉活动的瞬间波动。动脉自旋标记MRI技术将用于推断局部脑活动，因为这些激活代表相对稳定的状态。根据NCCIH的资助重点，本研究旨在增加对非药物治疗方法影响慢性疼痛和焦虑临床结局的机制的理解。结果将通过提供针对FAPD和共病焦虑的定制干预的改进和测试所需的关键信息来推进该领域-候选人的长期职业目标。在这项提案中，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，在强大的导师团队的指导下，研究儿科FAPD治疗反应的大脑机制。为了成功地执行这项研究并为独立的研究生涯做好准备，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）高级统计学。该提案将使候选人能够对FAPD的治疗反应机制有深入的了解，并制定独特的研究计划。结果将允许候选人测试量身定制的非药物干预与慢性疼痛的青年作为一个综合医学研究人员。