Department of Psychiatry and Neurosciences,Division of Frontier Graduate School of Biomedical Sciences,Hiroshima University,1-2-3 Kasumi,Minami-ku,Hiroshima 734-8551,Japan.
Department of Dental Anesthesiology,Hiroshima University,1-2-3 Kasumi,Minami-ku,Hiroshima 734-8551,Japan.
Psychol Med. 2018 May;48(7):1148-1156. doi: 10.1017/S0033291717002598. Epub 2017 Sep 12.
Cognitive-behavioral therapy (CBT) is thought to be useful for chronic pain, with the pathology of the latter being closely associated with cognitive-emotional components. However, there are few resting-state functional magnetic resonance imaging (R-fMRI) studies. We used the independent component analysis method to examine neural changes after CBT and to assess whether brain regions predict treatment response.
We performed R-fMRI on a group of 29 chronic pain (somatoform pain disorder) patients and 30 age-matched healthy controls (T1). Patients were enrolled in a weekly 12-session group CBT (T2). We assessed selected regions of interest that exhibited differences in intrinsic connectivity network (ICN) connectivity strength between the patients and controls at T1, and compared T1 and T2. We also examined the correlations between treatment effects and rs-fMRI data.
Abnormal ICN connectivity of the orbitofrontal cortex (OFC) and inferior parietal lobule within the dorsal attention network (DAN) and of the paracentral lobule within the sensorimotor network in patients with chronic pain normalized after CBT. Higher ICN connectivity strength in the OFC indicated greater improvements in pain intensity. Furthermore, ICN connectivity strength in the dorsal posterior cingulate cortex (PCC) within the DAN at T1 was negatively correlated with CBT-related clinical improvements.
We conclude that the OFC is crucial for CBT-related improvement of pain intensity, and that the dorsal PCC activation at pretreatment also plays an important role in improvement of clinical symptoms via CBT.
认知行为疗法（CBT）被认为对慢性疼痛有效，后者的病理学与认知情感成分密切相关。然而，很少有静息态功能磁共振成像（R-fMRI）研究。我们使用独立成分分析方法来研究 CBT 后的神经变化，并评估大脑区域是否可以预测治疗反应。
我们对 29 名慢性疼痛（躯体形式疼痛障碍）患者和 30 名年龄匹配的健康对照者（T1）进行了 R-fMRI 检查。患者参加了每周 12 次的小组 CBT（T2）。我们评估了 T1 时患者和对照组之间内在连通性网络（ICN）连通性强度存在差异的选定感兴趣区域，并比较了 T1 和 T2。我们还检查了治疗效果与 rs-fMRI 数据之间的相关性。
慢性疼痛患者的眶额皮层（OFC）和背侧注意网络（DAN）中的下顶叶以及感觉运动网络中的中央旁小叶的异常 ICN 连通性在 CBT 后恢复正常。OFC 的 ICN 连通性强度越高，疼痛强度的改善越大。此外，DAN 中的背侧后扣带回皮层（PCC）在 T1 时的 ICN 连通性强度与 CBT 相关的临床改善呈负相关。
我们得出结论，OFC 对于 CBT 相关的疼痛强度改善至关重要，并且在预处理时背侧 PCC 的激活也通过 CBT 对临床症状的改善起着重要作用。
