Stanford CAM Center for Chronic Back Pain

描述(由申请人提供)：直到最近，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、认知和行为还不清楚。使用实时功能磁共振成像(RtfMRI)神经反馈，我们最近证明，健康受试者和慢性疼痛患者可以学习控制前扣带皮质的活动，从而显著减少他们的疼痛，并在临床上有意义。我们建议将这一令人兴奋的发现推广到慢性下腰痛(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，但基础科学已经揭示，中枢痛觉调节和情绪调节系统的异常起着至关重要的作用。与此同时，一份强有力的临床文献表明，心身疗法(MBT)和认知/情绪调节策略在慢性疼痛管理中的价值。目前尚不清楚的是，基础和临床科学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。该项目建议使用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，然后将机械发现转化为优化慢性疼痛的临床治疗。我们将通过解决我们之前的rtfMRI研究中发现的三个问题来推进这一关键领域：(1)由于患者使用不同的认知策略来调节大脑活动，他们激活的大脑区域和学习控制中的有效性不同，(2)在单一区域反馈控制中，多个大脑区域被激活和去激活，这表明控制多个分布的区域可能比控制单个区域更有效，以及(3)在患者调节大脑活动的程度上存在显著的个体差异。因此，我们的总体目标是：(1)描述CLBP患者最佳控制单个和多个分布的大脑区域的认知策略，以及(2)确定rtfMRI缓解疼痛的介质。我们的总体目标是促进我们对身心疗法的科学知识，特别是如何通过学习控制特定的神经过程来减少慢性疼痛。

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.