Enhancing chronic low back pain management: an initial neuroimaging study of a mobile interoceptive attention training.

IF 2.5 Q2 CLINICAL NEUROLOGY Frontiers in pain research (Lausanne, Switzerland) Pub Date : 2024-09-30 eCollection Date: 2024-01-01 DOI:10.3389/fpain.2024.1408027
Irina A Strigo, Sergio Garcia Guerra, Salvatore Torrisi, Emily Murphy, Tiffany Toor, Veronica Goldman, Benedict J Alter, An Thanh Vu, Rich Hecht, Jeff Lotz, Alan N Simmons, Wolf E Mehling
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Abstract

Introduction: Chronic low back pain (cLBP) poses significant challenges, often addressed through avoidance or distraction. Emerging evidence suggests that mind-body interventions, like our novel Mind Your Pain (MyP) smartphone mobile application, may offer relief. We conducted a single-arm, mixed-methods neuroimaging study to assess the degree to which treatment response to our 8-week intervention, as measured by the reduction in the Pain, Enjoyment of Life and General Activity Scale (PEG), was associated with enhanced pain-related insula activation over time.

Methods: Twenty-nine individuals with cLBP completed patient-reported assessments, qualitative sensory testing (QST) measures, and neuroimaging pre- and post-MyP. Functional MRI data during experimental heat pain on the left forearm were collected and analyzed, comparing responders (≥50% reduction in PEG scores) and non-responders.

Results: MyP led to significant decreases in PEG scores overall. Furthermore, MyP responders exhibited increased pain-related activation in key brain regions, including the contralateral posterior insula, bilateral ventral anterior insula, ventral anterior cingulate, dorsolateral prefrontal cortex, and nucleus accumbens. Although baseline behavioral and sensory measures did not differ between the two responder groups, baseline neural differences related to the impact of the endogenous back pain were observed.

Discussion: MyP appears to modify pain response and underlying neural circuitry, suggesting neural changes in interoception may serve as biomarkers for mind-body interventions in cLBP. This study highlights the potential of MyP as a novel approach for cLBP management, warranting further investigation.

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加强慢性腰背痛管理:移动互感注意力训练的初步神经影像学研究。
导言:慢性腰背痛(cLBP)给人们带来了巨大的挑战,通常通过逃避或分散注意力来解决。新出现的证据表明,心身干预(如我们的新型智能手机应用程序 "Mind Your Pain (MyP)")可以缓解疼痛。我们进行了一项单臂、混合方法的神经影像学研究,以评估对我们为期 8 周的干预的治疗反应(以疼痛、生活享受和一般活动量表(PEG)的减少来衡量)在多大程度上与疼痛相关的脑岛激活随着时间的推移而增强相关:方法:29 名 cLBP 患者在接受 MyP 前后完成了患者报告评估、定性感觉测试 (QST) 测量和神经影像学检查。收集并分析左前臂热痛实验期间的功能磁共振成像数据,比较有反应者(PEG评分降低≥50%)和无反应者:结果:MyP使PEG评分总体上明显下降。此外,MyP应答者的主要脑区与疼痛相关的激活增加,包括对侧后脑岛、双侧腹腔前脑岛、腹腔前扣带回、背外侧前额叶皮层和凹凸核。虽然两组反应者的基线行为和感觉测量没有差异,但观察到了与内源性背痛影响有关的基线神经差异:讨论:MyP 似乎能改变疼痛反应和潜在的神经回路,这表明互感的神经变化可作为对 cLBP 进行身心干预的生物标志物。这项研究强调了 MyP 作为一种新方法治疗 cLBP 的潜力,值得进一步研究。
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