Gagnon Christine M, Scholten Paul, Atchison James, Jabakhanji Rami, Wakaizumi Kenta, Baliki Marwan
Shirley Ryan Abilitylab, Pain Management Center, Chicago, Illinois.
Department of PM&R, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
Pain Med. 2020 Nov 1;21(11):2765-2776. doi: 10.1093/pm/pnaa129.
The present study examined pre- to post-treatment changes in volumes for brain structures known to be associated with pain processing (thalamus, caudate, putamen, pallidum, hippocampus, amygdala, and accumbens) following an interdisciplinary pain management program.
Twenty-one patients participating in a four-week interdisciplinary pain management program completed the study. The program consisted of individual and group therapies with the following disciplines: physical therapy, occupational therapy, pain psychology, biofeedback/relaxation training, nursing lectures, and medical management. All patients underwent functional magnetic resonance imaging of the brain before the start and at completion of the program. They also completed standard outcome measures assessing pain, symptoms of central sensitization, disability, mood, coping, pain acceptance, and impressions of change.
Our results showed a significant increase in total brain volume, as well as increased volumes in the thalamus, hippocampus, and amygdala. As expected, we also found significant improvements in our standard outcome measures. The majority of patients rated themselves as much or very much improved. The increase in volume in the hippocampus was significantly associated with patient perceptions of change. However, the correlations were in the unexpected direction, such that greater increases in hippocampal volume were associated with perceptions of less improvement. Further exploratory analyses comparing patients by their opioid use status (use vs no use) showed differential program effects on volume increases in the hippocampus and amygdala.
These findings show that a four-week interdisciplinary pain management program resulted in changes in the brain, which adds objective findings further demonstrating program efficacy.
本研究考察了在一个跨学科疼痛管理项目之后，已知与疼痛处理相关的脑结构（丘脑、尾状核、壳核、苍白球、海马体、杏仁核和伏隔核）从治疗前到治疗后的体积变化。
21名参与为期四周跨学科疼痛管理项目的患者完成了该研究。该项目包括个体和团体治疗，涉及以下学科：物理治疗、职业治疗、疼痛心理学、生物反馈/放松训练、护理讲座和医疗管理。所有患者在项目开始前和结束时均接受了脑部功能磁共振成像检查。他们还完成了评估疼痛、中枢敏化症状、残疾、情绪、应对方式、疼痛接受度以及变化感受的标准结局指标。
我们的结果显示全脑体积显著增加，丘脑、海马体和杏仁核的体积也有所增加。正如预期的那样，我们还发现标准结局指标有显著改善。大多数患者将自己评为改善很多或非常多。海马体体积的增加与患者对变化的感受显著相关。然而，相关性方向出乎意料，即海马体体积增加越大，与改善较少的感受相关。通过比较患者的阿片类药物使用状态（使用与未使用）进行的进一步探索性分析显示，该项目对海马体和杏仁核体积增加有不同影响。
这些发现表明，为期四周的跨学科疼痛管理项目导致了脑部变化，这增加了客观发现，进一步证明了该项目的疗效。
