Brain Mechanisms Supporting the Modulation of Pain by Meditation and Placebo

描述（由申请人提供）：疼痛是一种涉及感觉、认知和情感机制的多维体验。这些因素之间的相互作用使得临床疼痛的治疗具有挑战性，并且通常是经济负担。正念冥想已被发现在实验和临床环境中显着改善疼痛症状，但缺乏机械数据限制了这种具有成本效益且无麻醉剂的治疗的临床部署。我们实验室的最新研究结果表明，经过四天（每天20分钟）的训练，冥想可以减少40%的疼痛强度和57%的疼痛不愉快评分。 采用一种新兴的MRI技术（动脉自旋标记），我们发现冥想相关的疼痛缓解与初级躯体感觉皮层中疼痛相关的大脑活动减少以及大脑区域（如前额叶皮层，前扣带皮层和眶额皮层）的活动增加有关。 这些区域参与认知控制、情绪调节和执行处理。这些发现表明，冥想在缓解疼痛时涉及多种大脑机制。然而，其他认知因素的贡献，如期望，促进者注意，焦虑减少，条件反射/消退过程仍然知之甚少。 这些因素与安慰剂效应密切相关。 因此，这项拟议中的研究旨在确定冥想相关的疼痛缓解是否涉及与安慰剂镇痛不同的大脑机制。将采用功能成像方法评估介质诱导的疼痛缓解期间和条件性安慰剂镇痛期间的脑激活。这项研究将为认知因素调节疼痛的神经机制提供重要的线索。

DESCRIPTION (provided by applicant): Pain is a multidimensional experience that involves sensory, cognitive and affective mechanisms. The constellation of interactions between these factors makes the treatment of clinical pain challenging and often a financial burden. Mindfulness meditation has been found to significantly improve pain symptoms in experimental and clinical settings, but lack of mechanistic data has limited clinical deployment of this cost- effective and narcotic-free treatment. Recent findings from our laboratory determined that meditation, after only four days (20 minutes/day) of training, reduced pain intensity by 40% and pain unpleasantness ratings by 57%. Employing an emerging MRI technique (arterial spin labeling), we found that meditation-related pain relief was associated reduced pain-related brain activity in the primary somatosensory cortex and increased activity in brain regions such as the anterior insula, anterior cingulate cortex, and orbitofrontal cortex. These latter regions are involved in cognitive control, emotion regulation, and executive processing. These findings demonstrate that meditation engages multiple brain mechanisms during pain relief. However, the contribution of other cognitive factors such as expectations, facilitator attention, anxiety reduction, and conditioning /extinction processes remains poorly understood. Such factors are critically involved in the placebo effect. Accordingly, the proposed study seeks to determine if meditation-related pain relief engages brain mechanisms that are distinct from those of placebo analgesia. Functional imaging methodologies will be employed to assess brain activation during mediation-induced pain relief and during conditioned placebo analgesia. The proposed investigation will provide significant insights into the neural substrates involved in the modulatin of pain by cognitive factors.