- ICH GCP
- Registro de ensaios clínicos dos EUA
- Ensaio Clínico NCT00796536
Using Functional MRI to Evaluate Cognitive Behavioral Therapy Treatment Response in Adults With Chronic Pain
Using fMRI to Evaluate CBT Treatment Response for Patients With Chronic Pain
Visão geral do estudo
Status
Condições
Intervenção / Tratamento
Descrição detalhada
Many recent studies have suggested that there is an overlap between pain and emotion-related neurophysiological processes. Several modern pain theories also advocate that pain should be considered as a complex sensory and emotional experience, rather than as an isolated sensory event. In accordance with these theories, it is reasonable to expect that an intervention such as CBT, which teaches patients to understand and control both the emotional and sensory aspects of pain, could alter the brain's responses to both pain and emotionally provocative stimuli and, consequently, change the underlying neural circuitry.
To date, there are no published studies that explore the neurobiological effects of psychotherapeutic approaches, such as CBT, on chronic pain. A previous pilot study showed that the exaggerated amygdala response to negative emotional stimuli in chronic pain patients was normalized after 12 weeks of group CBT, suggesting that CBT may affect at least the emotional component of the pain process. Using functional magnetic resonance imaging (fMRI), which creates a three-dimensional picture of the brain, this study will determine the following: (1) whether CBT treatment changes the function of brain neural circuitry in response to acute noxious physical stimuli and to fearful emotional stimuli; and (2) how altered activation in brain areas associated with the attentional, affective, and sensory aspects of chronic pain relate to measurable improvement in someone's clinical response to group CBT. Directly measuring the effects of CBT on brain function could ultimately improve clinical decision making and contribute to the development of individualized treatment for patients with chronic pain.
Participants will be randomly assigned to receive 12 weeks of either CBT or pain education, which will act as an attention control condition. Each CBT session will last for 90 minutes and will teach participants specific skills to better cope with chronic pain. These skills will include breathing exercises, distraction, and relaxation techniques. Each weekly pain education session, also lasting 90 minutes, will be structured as a group discussion and led by a health care counselor. During the session, participants will receive information about the nature of chronic back pain, talk about treatment options, learn exercises and stretching techniques for maintaining strength and flexibility, and learn how to protect their backs. Every participant will undergo two fMRI examinations: one before treatment and one after treatment.
Tipo de estudo
Inscrição (Real)
Estágio
- Fase 2
- Fase 1
Contactos e Locais
Locais de estudo
-
-
Vermont
-
Burlington, Vermont, Estados Unidos, 05401
- MindBody Medicine Clinic
-
-
Critérios de participação
Critérios de elegibilidade
Idades elegíveis para estudo
Aceita Voluntários Saudáveis
Gêneros Elegíveis para o Estudo
Descrição
Inclusion Criteria:
- At least 6 months of musculoskeletal non-neuropathic pain confined to lumbar or thoracic back
- Meets study threshold for severity of typical pain of 4 or more on a 10-point scale adapted from the McGill Pain Questionnaire
- Has ongoing standard pain management from a physician
- Agrees to participate in this research study
Exclusion Criteria:
- Malignancy
- Reflex sympathetic dystrophy and/or naturopathic pain
- Opioid medication use
- Substance use disorder
- Neurological disorder, such as epilepsy, stroke, or other medical condition that could confound or interfere with the current study
- Major depression or/and dysthymia
- Post traumatic stress disorder or panic disorder
- Left-handedness
- Pregnancy
- History of illicit drug use (cocaine, cannabis, heroin) that can result in altered cognition
- Exceeding the weight limit on the MRI scanner
- Suffering from claustrophobia
- Any of the following: cardiac pacemakers, auto defibrillators, neural stimulators, aneurysm clips, metallic prostheses, cochlear implants, any implanted devices (pumps, infusion devices, stents), permanent eye make-up, intrauterine devices, shrapnel injuries
Plano de estudo
Como o estudo é projetado?
Detalhes do projeto
- Finalidade Principal: Tratamento
- Alocação: Randomizado
- Modelo Intervencional: Atribuição Paralela
- Mascaramento: Nenhum (rótulo aberto)
Armas e Intervenções
Grupo de Participantes / Braço |
Intervenção / Tratamento |
---|---|
Experimental: 1
Participants will undergo 12 weeks of group cognitive behavioral therapy (CBT) and a pre- and post-intervention MRI brain scan.
|
Each CBT session will last for 90 minutes and will teach participants specific skills to better cope with chronic pain.
These skills will include breathing exercises, distraction, and relaxation techniques.
|
Comparador Ativo: 2
Participants will received 12 weeks of pain education and a pre- and post-intervention MRI brain scan.
|
Patients will receive mailed educational materials to their homes on a weekly basis.
Weekly materials will contain information about the nature of chronic back pain, treatment options, exercises and stretching techniques for maintaining strength and flexibility, and proper protection for a healthy back.
Pain education is the standard of care for most outpatient clinics.
|
O que o estudo está medindo?
Medidas de resultados primários
Medida de resultado |
Prazo |
---|---|
Thermal pain threshold, tolerance, perception of acute pain, ability to decrease pain, and brain reactivity
Prazo: Measured before and after the 12-week intervention
|
Measured before and after the 12-week intervention
|
Medidas de resultados secundários
Medida de resultado |
Prazo |
---|---|
Acute pain perception and brain activation correlated with improvement in clinical outcomes
Prazo: Measured before and after the 12-week intervention
|
Measured before and after the 12-week intervention
|
Colaboradores e Investigadores
Patrocinador
Investigadores
- Investigador principal: Magdalena R. Naylor, MD, PhD, MindBody Medicine Clinic, Department of Psychiatry, University of Vermont
Publicações e links úteis
Links úteis
Datas de registro do estudo
Datas Principais do Estudo
Início do estudo
Conclusão Primária (Real)
Conclusão do estudo (Real)
Datas de inscrição no estudo
Enviado pela primeira vez
Enviado pela primeira vez que atendeu aos critérios de CQ
Primeira postagem (Estimativa)
Atualizações de registro de estudo
Última Atualização Postada (Estimativa)
Última atualização enviada que atendeu aos critérios de controle de qualidade
Última verificação
Mais Informações
Termos relacionados a este estudo
Palavras-chave
Termos MeSH relevantes adicionais
Outros números de identificação do estudo
- R21AR055716 (Concessão/Contrato do NIH dos EUA)
Essas informações foram obtidas diretamente do site clinicaltrials.gov sem nenhuma alteração. Se você tiver alguma solicitação para alterar, remover ou atualizar os detalhes do seu estudo, entre em contato com register@clinicaltrials.gov. Assim que uma alteração for implementada em clinicaltrials.gov, ela também será atualizada automaticamente em nosso site .