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Using fMRI to investigate strategy-independent neural processes underlying cognitive modulation of pain
S96
Abstracts
The Journal of Pain
H. Treatment Approaches (Psychosocial & Cognitive)
(482) Working memory attenuates high pain
H01 Cognitive/Behavioral Approaches
Cognitive deficits and working memory (WM) problems have been well-documented in patients with chronic pain, yet previous studies investigating the relationship between memory and acute pain have shown mixed results. WM is the ability to maintain small amounts of information for a short period of time and is the precursor for more complex memory systems such as longterm memory. Disruptions in WM could impact the quality of, or whether or not, information moves to the next memory stage. In this study, we aim to characterize the relationship between working memory and acute pain processing in healthy individuals. We hypothesized:(1) increasing working memory loads will attenuate the participants’ pain perception of an acute noxious thermal stimulus, (2) increasing pain intensity will decrease participants’ performance on the working memory task, and (3) increasing pain intensity will increase participant’s response time on the working memory task. We used a Sternberg task and acute noxious thermal stimuli on 28 healthy participants. The Sternberg task measures working memory and recall through a presentation of letters, a delay, and then a letter cue asking the participant whether that letter was present in the previous string of letters. Each participant received a pseudorandom presentation of 4 different temperatures (baseline and individually determined low-, medium-, and high heat pain) and 4 different letter string lengths (0, 3, 6, and 9 letters). During each trial, we presented participants with a series of letters. Then we applied a noxious pain stimulus to their left thenar eminence and asked them to rate their pain. After the pain ratings, we asked them to recall whether or not they had seen a specific letter. We found that pain decreases as working memory load increases, but only for sufficiently noxious stimuli. However, increasing pain did not affect the participant’s accuracy or response time.
(480) Using fMRI to investigate strategy-independent neural processes underlying cognitive modulation of pain H Chapin, E Bagarinao, E Hubbard, K Wiley, H Ung, G Glover, and S Mackey; Stanford University, Stanford, CA The neural mechanisms behind effective cognitive control over pain experience are not well understood. This is partly due to substantial individual variability in the effectiveness of specific cognitive strategies used to modify pain. The purpose of the current study was to characterize the neural processes underlying successful cognitive modulation of acute pain regardless of strategy. We used fMRI on an enriched participant population of healthy controls that had previously shown the ability to change their acute pain ratings by 25% or more. Participants were asked to both increase and decrease their perception of pain elicited by moderately painful heat stimuli using cognitive strategies they felt worked best for them. They were given the freedom to choose from several suggested strategies or to utilize a personal strategy they found effective. It was important to allow this freedom because we were interested in effective cognitive control over pain experience rather than in neural activation related to specific strategies. We hypothesized that there would be differences between increase and decrease pain conditions in areas associated with pain experience and with general cognitive control. We found differences in the blood-oxygen-level-dependent (BOLD) signal between increase and decrease pain in areas known to be involved in pain processing, self-regulation, cognitive control, and in areas overlapping with the default mode network. Specifically, we found greater deactivation of mid-line frontal areas during increase pain and greater activation of lateral prefrontal areas during decrease pain. Connectivity analysis revealed greater connectivity during decrease pain of frontal areas involved in cognitive control with areas thought to be involved in the descending pain modulatory pathway. These results point to potential target areas for pain modulation using real-time fMRI neurofeedback.
(481) Acceptance, catastrophizing, and depressive symptoms in persons with disability-related chronic pain S Sullivan, D Ehde, J Turner, and T Dillworth; University of Washington, Seattle, WA The positive associations of pain-related catastrophizing with pain and depressive symptom levels among patients with chronic pain conditions have been observed for many years. More recently, the role of acceptance (willingness to experience pain and engage in valued activities despite pain) in minimizing the negative impact of chronic pain has received increasing attention. Despite the prevalence of chronic pain in individuals with disabilities, the relationships among catastrophizing, acceptance, pain, and depression have not been studied in this population. In the current study, we used baseline data from a sample of persons with disabilities (acquired amputation, multiple sclerosis, spinal cord injury) and chronic pain to test the hypothesis that acceptance would be negatively associated with depressive symptoms, even after controlling for pain intensity and catastrophizing. Participants (N = 102) were enrolled in a randomized-controlled trial comparing two telephone-delivered self-management interventions for chronic pain. The sample was 61% female (mean age = 54.3 years; SD = 10.6) and all participants reported pain for longer than six months. Prior to randomization, participants completed (via telephone) the Chronic Pain Acceptance Questionnaire, the Pain Catastrophizing Scale, and the Patient Health Questionnaire-8 depression scale. Participants also rated their average pain intensity in the past 24 hours on three separate days within one week; the mean was used to estimate pain intensity. In a hierarchical linear regression, with each variable entered in a separate step, after controlling for pain intensity (b = -.02, p > .05, DR2 = .04) and catastrophizing (b = .40, p < .001, DR2 = .37), acceptance (b = -.38, p < .001, DR2 = .08) was significantly and negatively associated with depressive symptom level. These findings support the growing body of empirical evidence linking acceptance, as well as catastrophizing, to psychological adjustment in persons with chronic pain and extend these findings to individuals with disabilities. Funded by NIH NCMRR Grant #5R011HD057916 to DME.
H Huynh, L Jastrzab, M Tieu, R McCue, V Gandhi, and S Mackey; Stanford University, Palo Alto, CA
(483) Objective assessment of physical activity in adolescents with juvenile fibromyalgia syndrome following cognitive-behavioral therapy S Sil, D Strotman, S Flowers, N Cunningham, T Ting, K Schikler, and S Kashikar-Zuck; Cincinnati Children’s Hospital Medical Center, Cincinnati, OH Juvenile fibromyalgia (JFM) is a chronic pain condition characterized by widespread pain and sleep difficulty. Adolescents with JFM typically have sedentary lifestyles despite medical recommendations to increase physical activity. Accurate assessment of physical activity is important in treatment studies that aim to improve physical functioning in JFM; however, objective measures of physical activity have been underutilized. The primary aim of this study was to examine changes in objectively measured physical activity within the context of a randomized clinical trial of cognitive-behavioral therapy (CBT) for adolescents with JFM. Baseline and post-treatment actigraphy measures were obtained for 68 adolescents (Mage = 15.15, 93% female) with JFM who participated in a clinical trial of CBT. Participants were randomized to 8 weeks of either CBT or fibromyalgia education (FE). Physical activity was assessed at baseline and post-treatment for one week using a hip-mounted omnidirectional accelerometer (Acticalª). T-tests were used to examine pre-post changes in average daily activity counts, peak activity, as well as average duration (in minutes per day) of sedentary, light, moderate, and vigorous activity. Those in FE did not exhibit any significant differences in physical activity from pre- to post-treatment. Contrary to expectation and in contrast to their self-report of overall improved functioning, adolescents in CBT did not show any significant increases in physical activity. In fact, the CBT group displayed small but significant decreases in peak activity (p = .01) and duration of light physical activity (p = .02) from preto post-treatment. CBT has minimal to no effect on improving moderate-vigorous physical activity levels in adolescents with JFM and some indicators showed slight decreases in activity after CBT. Potential reasons (increased activity pacing and relaxation) are discussed. Enhancing CBT with targeted physical exercise training should be considered to improve physical activity outcomes in JFM. Funded by NIAMS Grant #R01AR050028.
Abstracts
The Journal of Pain
H. Treatment Approaches (Psychosocial & Cognitive)
(482) Working memory attenuates high pain
H01 Cognitive/Behavioral Approaches
Cognitive deficits and working memory (WM) problems have been well-documented in patients with chronic pain, yet previous studies investigating the relationship between memory and acute pain have shown mixed results. WM is the ability to maintain small amounts of information for a short period of time and is the precursor for more complex memory systems such as longterm memory. Disruptions in WM could impact the quality of, or whether or not, information moves to the next memory stage. In this study, we aim to characterize the relationship between working memory and acute pain processing in healthy individuals. We hypothesized:(1) increasing working memory loads will attenuate the participants’ pain perception of an acute noxious thermal stimulus, (2) increasing pain intensity will decrease participants’ performance on the working memory task, and (3) increasing pain intensity will increase participant’s response time on the working memory task. We used a Sternberg task and acute noxious thermal stimuli on 28 healthy participants. The Sternberg task measures working memory and recall through a presentation of letters, a delay, and then a letter cue asking the participant whether that letter was present in the previous string of letters. Each participant received a pseudorandom presentation of 4 different temperatures (baseline and individually determined low-, medium-, and high heat pain) and 4 different letter string lengths (0, 3, 6, and 9 letters). During each trial, we presented participants with a series of letters. Then we applied a noxious pain stimulus to their left thenar eminence and asked them to rate their pain. After the pain ratings, we asked them to recall whether or not they had seen a specific letter. We found that pain decreases as working memory load increases, but only for sufficiently noxious stimuli. However, increasing pain did not affect the participant’s accuracy or response time.
(480) Using fMRI to investigate strategy-independent neural processes underlying cognitive modulation of pain H Chapin, E Bagarinao, E Hubbard, K Wiley, H Ung, G Glover, and S Mackey; Stanford University, Stanford, CA The neural mechanisms behind effective cognitive control over pain experience are not well understood. This is partly due to substantial individual variability in the effectiveness of specific cognitive strategies used to modify pain. The purpose of the current study was to characterize the neural processes underlying successful cognitive modulation of acute pain regardless of strategy. We used fMRI on an enriched participant population of healthy controls that had previously shown the ability to change their acute pain ratings by 25% or more. Participants were asked to both increase and decrease their perception of pain elicited by moderately painful heat stimuli using cognitive strategies they felt worked best for them. They were given the freedom to choose from several suggested strategies or to utilize a personal strategy they found effective. It was important to allow this freedom because we were interested in effective cognitive control over pain experience rather than in neural activation related to specific strategies. We hypothesized that there would be differences between increase and decrease pain conditions in areas associated with pain experience and with general cognitive control. We found differences in the blood-oxygen-level-dependent (BOLD) signal between increase and decrease pain in areas known to be involved in pain processing, self-regulation, cognitive control, and in areas overlapping with the default mode network. Specifically, we found greater deactivation of mid-line frontal areas during increase pain and greater activation of lateral prefrontal areas during decrease pain. Connectivity analysis revealed greater connectivity during decrease pain of frontal areas involved in cognitive control with areas thought to be involved in the descending pain modulatory pathway. These results point to potential target areas for pain modulation using real-time fMRI neurofeedback.
(481) Acceptance, catastrophizing, and depressive symptoms in persons with disability-related chronic pain S Sullivan, D Ehde, J Turner, and T Dillworth; University of Washington, Seattle, WA The positive associations of pain-related catastrophizing with pain and depressive symptom levels among patients with chronic pain conditions have been observed for many years. More recently, the role of acceptance (willingness to experience pain and engage in valued activities despite pain) in minimizing the negative impact of chronic pain has received increasing attention. Despite the prevalence of chronic pain in individuals with disabilities, the relationships among catastrophizing, acceptance, pain, and depression have not been studied in this population. In the current study, we used baseline data from a sample of persons with disabilities (acquired amputation, multiple sclerosis, spinal cord injury) and chronic pain to test the hypothesis that acceptance would be negatively associated with depressive symptoms, even after controlling for pain intensity and catastrophizing. Participants (N = 102) were enrolled in a randomized-controlled trial comparing two telephone-delivered self-management interventions for chronic pain. The sample was 61% female (mean age = 54.3 years; SD = 10.6) and all participants reported pain for longer than six months. Prior to randomization, participants completed (via telephone) the Chronic Pain Acceptance Questionnaire, the Pain Catastrophizing Scale, and the Patient Health Questionnaire-8 depression scale. Participants also rated their average pain intensity in the past 24 hours on three separate days within one week; the mean was used to estimate pain intensity. In a hierarchical linear regression, with each variable entered in a separate step, after controlling for pain intensity (b = -.02, p > .05, DR2 = .04) and catastrophizing (b = .40, p < .001, DR2 = .37), acceptance (b = -.38, p < .001, DR2 = .08) was significantly and negatively associated with depressive symptom level. These findings support the growing body of empirical evidence linking acceptance, as well as catastrophizing, to psychological adjustment in persons with chronic pain and extend these findings to individuals with disabilities. Funded by NIH NCMRR Grant #5R011HD057916 to DME.
H Huynh, L Jastrzab, M Tieu, R McCue, V Gandhi, and S Mackey; Stanford University, Palo Alto, CA
(483) Objective assessment of physical activity in adolescents with juvenile fibromyalgia syndrome following cognitive-behavioral therapy S Sil, D Strotman, S Flowers, N Cunningham, T Ting, K Schikler, and S Kashikar-Zuck; Cincinnati Children’s Hospital Medical Center, Cincinnati, OH Juvenile fibromyalgia (JFM) is a chronic pain condition characterized by widespread pain and sleep difficulty. Adolescents with JFM typically have sedentary lifestyles despite medical recommendations to increase physical activity. Accurate assessment of physical activity is important in treatment studies that aim to improve physical functioning in JFM; however, objective measures of physical activity have been underutilized. The primary aim of this study was to examine changes in objectively measured physical activity within the context of a randomized clinical trial of cognitive-behavioral therapy (CBT) for adolescents with JFM. Baseline and post-treatment actigraphy measures were obtained for 68 adolescents (Mage = 15.15, 93% female) with JFM who participated in a clinical trial of CBT. Participants were randomized to 8 weeks of either CBT or fibromyalgia education (FE). Physical activity was assessed at baseline and post-treatment for one week using a hip-mounted omnidirectional accelerometer (Acticalª). T-tests were used to examine pre-post changes in average daily activity counts, peak activity, as well as average duration (in minutes per day) of sedentary, light, moderate, and vigorous activity. Those in FE did not exhibit any significant differences in physical activity from pre- to post-treatment. Contrary to expectation and in contrast to their self-report of overall improved functioning, adolescents in CBT did not show any significant increases in physical activity. In fact, the CBT group displayed small but significant decreases in peak activity (p = .01) and duration of light physical activity (p = .02) from preto post-treatment. CBT has minimal to no effect on improving moderate-vigorous physical activity levels in adolescents with JFM and some indicators showed slight decreases in activity after CBT. Potential reasons (increased activity pacing and relaxation) are discussed. Enhancing CBT with targeted physical exercise training should be considered to improve physical activity outcomes in JFM. Funded by NIAMS Grant #R01AR050028.