Identifying EEG Markers of Altered Interoceptive Processing in Chronic Pain

项目总结： 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，需要更好地科学理解 慢性疼痛的神经和心理生物学基础是明确的，以指导改进的治疗方法。 非药物干预，包括冥想和综合实践，在以下方面显示出有效性 改善疼痛，加强努力，减少阿片类药物的医疗管理。这些干预措施往往针对 内部痛觉和非痛觉信号的处理，称为内感。神经处理 内感刺激与慢性疼痛中改变的许多区域重叠，并自我报告内感 问卷和任务显示疼痛患者的内感表现减弱。然而，翻译的 由于缺乏明确的任务，疼痛治疗轨迹中的内感功能的相关性受到阻碍 以及内部知觉的问卷测量。 这项建议的总体目标是确定非痛性内感的神经加工是否 慢性下腰痛患者的刺激，即心跳，在治疗的不同阶段和 与健康成年人相比，对侵入性外周靶向治疗无反应的预测。这个NRSA 该项目将确定电生理动力学(脑电/心电)如何与内感过程和 使用两个新开发的、经过验证的、严格控制的内部感觉任务进行疼痛治疗反应 评估神经对心脏的反应(心跳诱发电位，HEP)。我将系统地测试 慢性疼痛患者注意时HEP调制减弱的假说 他们的心跳与健康对照组(目标1)和内感-外感受损的比较 当先前与心跳同步的外部感觉音出乎意料地被整合时 已省略(目标2)。我还将测试这些基线测量是否可以预测对疼痛的无反应 干预。综合起来，这些数据将确定非痛性内感加工的神经标记物 可能是临床相关的生物标志物，用于指导慢性下腰痛的治疗选择，并将具有 对整合针对内感加工的行为干预具有广泛的意义。在……里面 为了准备这次NRSA，我已经找到了在内感任务方面有专长的导师， 电生理(脑电和心电)数据采集、分析和解释，临床介入性疼痛 管理，以及补充和综合的疼痛护理。这项提议是为了给我提供培训 作为一名从事内感动力学研究的疼痛管理内科医生，未来的职业需要 在慢性疼痛中的作用，以及它们与中西医结合治疗的关系。

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.