The primary goal of this revised R21 application is to investigate whether a psychotherapeutic approach, group Cognitive Behavioral Therapy (CBT), modifies the dysfunctional emotional and sensory neural circuitry associated with chronic pain as examined by functional magnetic resonance imaging (fMRI). We propose to apply previously tested and accepted paradigms for symptom provocation (acute pain and negative emotional stimuli) to investigate CBT effects on neural correlates of chronic pain. Because chronic pain is not just an isolated sensory event but rather a complex sensory and emotional experience, it is reasonable to expect that an intervention which improves chronic pain such as CBT will alter responses to both painful and emotionally provocative stimuli and thus the underlying neural circuitry. The efficacy of a group CBT treatment modality for chronic pain patients has been well established. In addition, our fMRI pilot study results revealed that the exaggerated amygdala response to negative emotional stimuli in chronic pain patients was normalized after 12 weeks of group CBT, suggesting that CBT may affect at least the emotional component of the pain process. Forty subjects who meet inclusion and exclusion criteria for the fMRI study will be randomly assigned to two study conditions: 12-week group CBT Treatment Condition and Attention Control Condition. Each participant will undergo two fMRI examinations (before and after group interventions) to explore two study goals: 1) whether CBT treatment changes the function of brain neural circuity in response to application of acute noxious stimuli and emotional (fearful) stimuli; 2) whether there is a relationship between altered activation in brain areas associated with the attentional, affective, and sensory aspects of chronic pain and quantifiable improvement in clinical measures reported at the conclusion of group CBT. Our approach is novel as there are no published studies that explore the neurobiological effects of psychotherapeutic approaches in chronic pain. By combining a noxious pain stimulation paradigm, an emotional stimulation paradigm, and brain imaging, and putting this approach into a clinical framework, we will open important, new avenues of research on chronic pain. Our approach may represent a valuable strategy for advancing our understanding of the neurobiology of emotional control related to pain and the effects of cognitive-behavioral therapy in the group setting. Measuring directly the effects of CBT on brain function could ultimately improve clinical decision making and contribute to development of the individualized treatment of patients with chronic pain.
This proposed study will test the hypothesis that cognitive-behavioral therapy (CBT) can modify the dysfunctional neural circuitry associated with chronic pain. Because chronic pain is considered a complex sensory and emotional experience we expect that an intervention such as CBT could alter patients' responses to both painful and emotionally provocative stimuli and thus the underlying neural circuitry tested by fMRI. We believe that our paradigm represents a valuable strategy for advancing our understanding of the neurobiology of emotional control related to pain and the effects of CBT in the group setting.
| Lieberman, Gregory; Shpaner, Marina; Watts, Richard et al. (2014) White matter involvement in chronic musculoskeletal pain. J Pain 15:1110-1119 |
| Shpaner, Marina; Kelly, Clare; Lieberman, Greg et al. (2014) Unlearning chronic pain: A randomized controlled trial to investigate changes in intrinsic brain connectivity following Cognitive Behavioral Therapy. Neuroimage Clin 5:365-76 |
| Seminowicz, David A; Shpaner, Marina; Keaser, Michael L et al. (2013) Cognitive-behavioral therapy increases prefrontal cortex gray matter in patients with chronic pain. J Pain 14:1573-84 |
