Health Science Graduate Program, Federal University of Sergipe, Aracaju, SE, Brazil; Department of Physical Therapy, Federal University of Sergipe, Aracaju, SE, Brazil.
Physiological Sciences Graduate Program, Federal University of Sergipe, Aracaju, SE, Brazil; Department of Physical Therapy, Federal University of Sergipe, Aracaju, SE, Brazil.
Complement Ther Med. 2018 Aug;39:137-145. doi: 10.1016/j.ctim.2018.06.006. Epub 2018 Jun 19.
There are different ways of dealing with pain and cognitive and meditative therapies (CMT) are alternative ways to regulate the emotions associated with pain. Current studies apply neuroimaging techniques trying to elucidate the neural mechanisms of cognitive strategies for pain. This systematic review aimed to summarize the evidence on brain activity changes after CMT, which include cognitive behavioral therapy, mindfulness and/or meditation, for pain management as well as to evaluate clinical pain outcomes.
Electronic databases - Pubmed, EMBASE, PsycINFO, Science Direct, Scopus - were searched to find randomized controlled trials (RCTs) examining neuroimaging data of CMT for chronic pain patients or healthy individuals with experimental pain. Two reviewers independently selected the relevant trials, rated for quality assessment and extracted all data using a standardized form. Primary outcome was brain activity changes (activation, deactivation or functional connectivity). Secondary outcomes were pain intensity, self-management, pain coping, quality of life, anxiety and depression.
Nine RCTs were included involving 280 adults (18-59 years), 139 chronic pain patients vs. 148 healthy subjects. Three main kinds of intervention were identified: cognitive-behavioral therapy (n = 4), mindfulness meditation (n = 4) and transcendental meditation technique (n = 1). Neuroimaging results revealed distinct patterns of activity, but the main findings were related to increased activation of prefrontal cortex (PFC), specially dorsolateral prefrontal cortex (dlPFC) and ventrolateral prefrontal cortex (vlPFC), orbitofrontal cortex (OBF), somatosensory cortices (SSC) and limbic system in chronic pain population; and increased activation of anterior cingulate cortex (ACC), anterior insular cortex (AI) and decreased activation of thalamus in healthy individuals following CMT.
This result means that regulation of pain by CMT can alter functioning of brain regions in an extensive network including non-nociceptive regions. CMT reduced the affective experience of pain, while reductions of pain intensity ratings were less consistent. Brain changes have been demonstrated as a result of the application of psychological measures and may represent the clinical implications of changes in brain activity or morphology.
有不同的方法可以处理疼痛，认知和冥想疗法（CMT）是调节与疼痛相关情绪的替代方法。目前的研究应用神经影像学技术试图阐明认知策略对疼痛的神经机制。本系统综述旨在总结 CMT（包括认知行为疗法、正念和/或冥想）用于疼痛管理后大脑活动变化的证据，以及评估临床疼痛结果。
电子数据库 - Pubmed、EMBASE、PsycINFO、Science Direct、Scopus - 被搜索以找到检查慢性疼痛患者或有实验性疼痛的健康个体的 CMT 神经影像学数据的随机对照试验（RCT）。两位审查员独立选择相关试验，对质量评估进行评分，并使用标准化表格提取所有数据。主要结果是大脑活动变化（激活、失活或功能连接）。次要结果是疼痛强度、自我管理、疼痛应对、生活质量、焦虑和抑郁。
纳入了 9 项 RCT，共涉及 280 名成年人（18-59 岁），139 名慢性疼痛患者与 148 名健康受试者。确定了三种主要的干预措施：认知行为疗法（n=4）、正念冥想（n=4）和超越冥想技术（n=1）。神经影像学结果显示出不同的活动模式，但主要发现与慢性疼痛人群中前额叶皮层（PFC），特别是背外侧前额叶皮层（dlPFC）和腹外侧前额叶皮层（vlPFC）、眶额皮层（OBF）、体感皮层（SSC）和边缘系统的活动增加有关；以及健康个体在接受 CMT 后前扣带皮层（ACC）、前岛叶皮层（AI）的活动增加和丘脑的活动减少。
这一结果意味着 CMT 对疼痛的调节可以改变包括非伤害性区域在内的广泛网络中大脑区域的功能。CMT 减轻了疼痛的情感体验，而疼痛强度评分的降低则不太一致。大脑变化已被证明是心理措施应用的结果，可能代表大脑活动或形态变化的临床意义。
