Chronic pain is a serious public health problem that causes significant economic loss and suffering. Conventional treatments are often ineffective, leaving patients with substantial pain and impaired quality-of-life. Mindfulness Based Stress Reduction (MBSR) is a protocolized CAM therapy based on Buddhist meditation practices: practitioners cultivate non-judgmental attention to the breath and sensory feelings as a way of focusing on and being mindful of the present moment. MBSR is a promising therapy for chronic pain, implemented in many major medical centers worldwide. While understanding of specific mechanisms underlying MBSR for chronic pain is poor, in healthy individuals, at least one study has found that MBSR elicits changes over the central sulcus in the neocortex, the cortical entry point where bodily feelings are processed. These same cortical areas are abnormal in chronic pain patients: in Brodmann Area (BA) 3b,the representation of the painful part is abnormally large and fragmented. The research application tests the specific hypothesis that MBSR elicits therapeutic cortical plasticity in BA 3b by carrying out a RCT in 60 chronic pain patients, using functional magnetic resonance imaging (fMRI) to compare MBSR's efficacy in normalizing cortical maps with that of attention and wait-list control. In addition to the research application, the training program includes formal education in 1) fMRI neuroimaging methods, 2) basic neuroscience, 3) biostatistical methods related to fMRI. This training prepares me to meet my long-term objective of becoming an independent neuroscientist. Through formal didactic instruction and strong mentoring from experienced investigators who are leaders in the field, I will develop the requisite tools to shed light on cortical mechanisms underlying chronic pain and MBSR. This application meets the NCCAM strategic plan's call for studies investigating neural mechanisms underlying mind-body therapies. In its development of a specific replicable experimental model for examining cortical body maps, it has broad implications for our understanding of CAM therapies. Specifically, in its rigorous study of a neural substrate underlying human embodied experience, this research application has great potential significance for understandings of a mechanism underlying mind-body CAM therapies for chronic pain.
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