"Using fMRI to evaluate CBT Treatment Response For Patients With Chronic Pain"
The purpose of this study is to investigate whether a psychotherapeutic approach, group Cognitive Behavioral Therapy (CBT), alters the dysfunctional emotional and sensory neural circuitry associated with chronic pain as examined by functional magnetic resonance imaging (fMRI). MRI is a three dimensional picture of the brain using magnetic waves. Researchers are able to utilize functional MRI while participants are performing various tasks to examine what areas of the brain are activated by each particular task. In this study participants will be asked to perform two types of tasks.
Since chronic pain is not just an isolated sensory event but rather a complex sensory and emotional experience we plan to test both a painful thermal stimuli paradigm as well as an emotional provocative stimuli paradigm to see whether there is a relationship between changes in brain activation areas associated with the attentional, affective, and sensory aspects of chronic pain as well as quantifiable improvement in clinical measures (questionnaires) reported at the conclusion of group CBT.
Forty subjects who meet our inclusion and exclusion criteria will be recruited, consented and randomly assigned to one of two study conditions:
Prior to the onset of their treamtent, study participants will undergo the first of two fMRI scanning sessions where they will be asked to perform tasks while being scanned. Each participant will also complete clincial questionnaires about their pain, coping and mood. Next, participants will commence with 12 consecutive weeks of either group CBT or an educational group based on randomized assignment. Upon completion of their twelve week intervention, participants will undergo their second fMRI scanning session and those participants who took part in the educational group are allowed to begin group CBT if they desire. Participants are reimbursed with a stipend for their time and participation.
Click here to view an online video orientation for research participants.
The primary goal of this project is to investigate whether group CBT can modify the dysfunctional neural circuitry associated with 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 study is pending funding from an R21 grant from NIH/NIAMS awarded to Magdalena Naylor, MD, PhD, Principal Investigator.
UVM Functional Brain Imaging Program