Identifying EEG Markers of Altered Interoceptive Processing in Chronic Pain

识别慢性疼痛中内感受处理改变的脑电图标记

• 批准号: 10606187
• 负责人: Chloe S Zimmerman
• 金额: $ 5.18万
• 依托单位: BROWN UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-06-01 至 2027-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10606187
• 关键词: Acute Pain; Adult; Agreement; Attention; Back; Back Pain; Behavior Therapy; Behavioral; Biological Markers; Brain region; Cardiac; Caring; Central Nervous System; Chronic; Chronic low back pain; Clinical; Complex; Continuity of Patient Care; Data; Diagnosis; Disease; Early identification; Electrocardiogram; Electroencephalography; Electrophysiology (science); Evoked Potentials; Funding; Future; Healthcare Systems; Heart; Impairment; Implant; Integrative Medicine; Interoception; Intervention; Knowledge; Lead; Link; Low Back Pain; Measurement; Measures; Medical; Mentors; Mind-Body Intervention; Modality; Moods; Motivation; National Research Service Awards; Neurostimulation procedures of spinal cord tissue; Noise; Operative Surgical Procedures; Pain; Pain management; Painless; Parents; Participant; Patient Recruitments; Patient Self-Report; Patients; Performance; Peripheral; Persistent pain; Phase; Physicians; Positioning Attribute; Preparation; Prevalence; Probability; Process; Prosencephalon; Qi Gong; Questionnaires; Research; Running; Selection for Treatments; Sensory; Severities; Signal Transduction; Spinal Cord; Spine surgery; Stimulus; Syndrome; Tai Ji; Testing; Time; Training; Treatment Efficacy; Work; attentional modulation; central pain; chronic pain; chronic pain patient; clinically relevant; comparison control; daily pain; data acquisition; design; experience; experimental study; healing; improved; indexing; mindfulness; multimodality; neural; neuromechanism; observational cohort study; opioid epidemic; pain chronification; pain patient; pain perception; pain reduction; pain relief; paired stimuli; patient population; peripheral pain; primary outcome; prospective; psychobiologic; recruit; remediation; response; secondary analysis; secondary outcome; smartphone application; treatment comparison; treatment response

PROJECT SUMMARY: Chronic pain is a complex, medically unexplained disorder that poses enormous burden to both the patient and the healthcare system. In the face of the opioid epidemic, the need for better scientific understanding of the neuro- and psycho-biological underpinnings of chronic pain to guide improved treatment approaches is clear. Non-pharmacological interventions, including contemplative and integrative practices, have shown efficacy in improving pain and bolster efforts to reduce opioid-ergic medical management. These interventions often target the processing of internal painful and non-painful sensory signals, referred to as interoception. Neural processing of interoceptive stimuli overlaps with many of the regions altered in chronic pain, and self-report interoceptive questionnaires and tasks show diminished interoceptive performance in pain patients. However, the translational relevance of interoceptive functioning in pain treatment trajectories has been hindered by the lack of clear tasks and questionnaire measures of interoception. The overall objective of this proposal is to establish whether neural processing of non-painful interoceptive stimuli, namely the heartbeat, is altered in chronic low back pain patients at various stages of treatment and predictive of non-response to invasive peripherally-targeted treatments compared to healthy adults. This NRSA project will identify how electrophysiological dynamics (EEG/ECG) are related to interoceptive processes and pain treatment response using two newly developed, validated, and rigorously controlled interoception tasks that assess neural responses to the heart (Heartbeat-Evoked Potential, HEP). I will systematically test the hypothesis that chronic pain patients will display diminished modulation of the HEP during attention to their heartbeat compared to healthy controls (Aim 1) and impaired interoceptive-exteroceptive integration when an exteroceptive tone previously synchronized with the heartbeat is unexpectedly omitted (Aim 2). I will also test that these measures at baseline can predict non-response to pain intervention. Together, these data will establish whether neural markers of non-painful interoceptive processing could be clinically relevant biomarkers for guiding treatment selection in chronic low back pain, and would have broad implications for the incorporation of behavioral interventions targeting interoceptive processing. In preparation for this NRSA, I have sought out mentors who have expertise in interoceptive tasks, electrophysiology (EEG and ECG) data acquisition, analysis and interpretation, clinical interventional pain management, and complementary and integrative pain care. This proposal was designed to give me the training needed for a future profession as a Pain Management physician conducting research on interoceptive dynamics in chronic pain, and their relation to healing with integrative medicine modalities.

项目概要： 慢性疼痛是一种复杂的、医学上无法解释的疾病，给患者和 医疗保健系统。面对阿片类药物的流行，需要更好地科学了解 慢性疼痛的神经和心理生物学基础，以指导改进的治疗方法是明确的。 非药物干预，包括治疗性和综合性做法，已显示出有效性， 改善疼痛和加强努力，以减少阿片类药物能的医疗管理。这些干预措施往往针对 内部疼痛和非疼痛感觉信号的处理，称为内感受。神经处理 内感受性刺激与慢性疼痛中改变的许多区域重叠， 问卷和任务显示疼痛患者的内感受性表现减弱。然而，翻译 内感受功能在疼痛治疗轨迹中的相关性由于缺乏明确的任务而受到阻碍 和内感受的问卷测量。 这项建议的总体目标是确定非疼痛内感受性的神经处理是否 刺激，即心跳，在治疗的各个阶段在慢性腰痛患者中改变， 与健康成人相比，预测对侵入性外周靶向治疗无反应。这个NRSA 该项目将确定电生理动力学（EEG/ECG）如何与内感受过程相关， 疼痛治疗反应使用两个新开发的，验证的，严格控制的内感受任务， 评估对心脏的神经反应（心跳诱发电位，HEP）。我将系统地测试 假设慢性疼痛患者在注意力集中期间将显示HEP的调节减弱， 他们的心跳与健康对照组相比（Aim 1）， 当先前与心跳同步的外感受音意外地 省略（目标2）。我还将测试这些基线测量值是否可以预测对疼痛无反应 干预总之，这些数据将确定非疼痛内感受性处理的神经标志物是否 可能是指导慢性腰痛治疗选择的临床相关生物标志物， 广泛的影响，纳入行为干预，针对内感受性处理。在 为了准备这次NRSA，我找了一些在内感受任务方面有专长的导师， 电生理学（EEG和ECG）数据采集、分析和解释，临床介入疼痛 管理，以及补充和综合疼痛护理。这份计划书是为了训练我 作为一个未来的职业需要疼痛管理医生进行内感受动力学研究 在慢性疼痛中的作用，以及它们与中西医结合治疗的关系。