Brain Mechanisms Supporting Mindfulness Meditation-Based Chronic Pain Relief

项目摘要 疼痛是一种涉及感觉、认知和情感因素的多维体验。星座 这些因素之间的相互作用使得慢性疼痛的治疗具有挑战性，并且通常是经济上的。 负担事实上，慢性疼痛影响着超过1亿美国人， 每年6350亿美元。阿片类药物治疗慢性疼痛的广泛使用导致了所谓的“阿片类药物 由于阿片类药物滥用和成瘾的指数增长，这些惊人的统计数据凸显了 开发、测试和验证快速起效的非药物治疗疼痛方法的重要性。 正念冥想是一种技术，已被发现显着减少疼痛的实验和 临床环境。然而，缺乏机械的数据和假设，广泛的冥想训练是 需要经历镇痛限制了这种具有成本效益和无麻醉剂的临床部署 治疗我们实验室最近的发现表明，仅仅经过四次冥想， (20分钟/会话）的训练，显着降低疼痛强度和不愉快的评级。跨两 功能性神经影像学研究，采用基于灌注的MRI（动脉自旋标记），我们发现， 正念冥想引起的疼痛缓解与右前额叶的更大激活相关， （aINS）、眶额（OFC）和膝下前扣带（sgACC）皮质。我们还发现 冥想相关镇痛与丘脑失活有关。这些发现证明 正念冥想通过多种大脑机制减少疼痛， 控制、情绪调节和上行伤害性输入的衰减。然而，这些结果不能 一般化为慢性疼痛，因为它们与健康，无痛的参与者和热 诱发疼痛。重要的是，支持正念调节慢性疼痛的大脑机制 冥想仍然是未知的。因此，拟议R 01研究的中心目的是确定 支持调节急性加重的慢性下背痛的机制， 经济负担的慢性疼痛状况，通过急性训练的正念冥想。我们将确定是否 发现通过正念冥想减弱实验诱导的疼痛的神经机制（即，OFC， sgACC，丘脑）也与调节慢性腰痛有关。也不知道有多少 需要训练来增强大脑机制之间的假设关系， 正念冥想和慢性腰痛缓解。因此，我们将检查，如果冥想，经过较长的回合 冥想训练，将增加冥想引起的大脑激活之间的假设关系， (i.e., OFC、sgACC、aINS）和慢性腰痛缓解。从拟议的方案中获得的知识 研究将提供新的机制见解，以更好地开发和定制认知干预措施，以针对多种 慢性疼痛状况。

Project Summary Pain is a multidimensional experience that involves sensory, cognitive and affective factors. The constellation of interactions between these factors renders the treatment of chronic pain challenging and often a financial burden. In fact, chronic pain affects over 100 million Americans and costs the United States approximately $635 billion dollars a year. The widespread use of opioids to treat chronic pain has led to the so-called “opioid epidemic” due to the exponential growth in opioid misuse and addiction. These staggering statistics highlight the importance of developing, testing and validating fast-acting, non-pharmacological approaches to treat pain. Mindfulness meditation is a technique that has been found to significantly reduce pain in experimental and clinical settings. However, lack of mechanistic data and the assumption that extensive meditation training is required to experience analgesia has limited the clinical deployment of this cost-effective and narcotic-free treatment. Recent findings from our laboratory determined that mindfulness meditation, after only four sessions (20 minutes/session) of training, dramatically reduces pain intensity and unpleasantness ratings. Across two functional neuroimaging studies, employing perfusion-based MRI (arterial spin labeling), we found that mindfulness meditation-induced pain relief was associated with greater activation of the right anterior insula (aINS), orbitofrontal (OFC) and subgenual anterior cingulate (sgACC) cortex. We have also found that meditation-related analgesia was associated with significant thalamic deactivation. These findings demonstrate that mindfulness meditation reduces pain through multiple brain mechanisms related to increased cognitive control, emotion regulation and attenuation of ascending nociceptive input. However, these results cannot be generalized to chronic pain because they were associated with healthy, pain-free participants and thermally induced pain. Importantly, the brain mechanisms supporting the modulation of chronic pain by mindfulness meditation remain unknown. Thus, the central aim of the proposed R01 study is to determine the specific mechanisms supporting the modulation of acutely exacerbated chronic low-back pain, the most prevalent and financially burdensome chronic pain condition, by acutely trained mindfulness meditation. We will determine if the neural mechanisms found to attenuate experimentally induced pain by mindfulness meditation (i.e., OFC, sgACC, thalamus) are also associated with modulating chronic low back pain. It is also unknown how much training is required to enhance the hypothesized relationship between the brain mechanisms supporting mindfulness meditation and chronic low-back pain relief. Thus, we will examine if meditation, after longer bouts of meditation training, will increase the hypothesized relationship between meditation-induced brain activation (i.e., OFC, sgACC, aINS) and chronic low back pain relief. The knowledge to be gained from the proposed study will provide novel mechanistic insight to better develop and tailor cognitive interventions to target multiple chronic pain conditions.