Changes in resting-state brain networks after cognitive–behavioral therapy for chronic pain

AbstractBackgroundCognitive–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.MethodsWe 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.ResultsAbnormal 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.ConclusionsWe 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.

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The Effect of Cognitive-Behavioral Therapy on Pain Intensity in Patients with Chronic Pain

The Neuroscience Journal of Shefaye Khatam ◽

10.18869/acadpub.shefa.3.3.70 ◽

2015 ◽

Vol 3 (3) ◽

pp. 70-75 ◽

Cited By ~ 1

Author(s):

Pirhossein Kolivand ◽

Azadeh Nazari Mahin ◽

Robabeh Jafari ◽

◽

...

Keyword(s):

Chronic Pain ◽

Cognitive Behavioral Therapy ◽

Pain Intensity ◽

Behavioral Therapy ◽

Cognitive Behavioral

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Clinical Effectiveness and Cost-effectiveness of Videoconference-Based Integrated Cognitive Behavioral Therapy for Chronic Pain: Randomized Controlled Trial (Preprint)

10.2196/preprints.30690 ◽

2021 ◽

Author(s):

Kayoko Taguchi ◽

Noriko Numata ◽

Rieko Takanashi ◽

Ryo Takemura ◽

Tokiko Yoshida ◽

...

Keyword(s):

Chronic Pain ◽

Cognitive Behavioral Therapy ◽

Pain Intensity ◽

Rating Scale ◽

Numerical Rating Scale ◽

Behavioral Therapy ◽

Controlled Trial ◽

Brief Pain Inventory ◽

Cognitive Behavioral ◽

Pain Interference

BACKGROUND Cognitive behavioral therapy is known to improve the management of chronic pain. However, the components of this therapy are still being investigated and debated. OBJECTIVE This study aimed to examine the effectiveness of an integrated cognitive behavioral therapy program with new components (attention-shift, memory work, video feedback, and image training) delivered via videoconferencing. METHODS This study was unblinded and participants were recruited and assessed face-to-face in the outpatient department. We conducted a randomized controlled trial for chronic pain to compare 16 weekly videoconference-based cognitive behavioral therapy (vCBT) sessions provided by a therapist with treatment as usual (TAU). Thirty patients (age range, 22-75 years) with chronic pain were randomly assigned to either vCBT (n=15) or TAU (n=15). Patients were evaluated at week 1 (baseline), week 8 (midintervention), and week 16 (postintervention). The primary outcome was the change in pain intensity, which was recorded using the numerical rating scale at 16 weeks from the baseline. Secondary outcomes were pain severity and pain interference, which were assessed using the Brief Pain Inventory. Additionally, we evaluated disability, pain catastrophizing cognition, depression, anxiety, quality of life, and cost utility. RESULTS In the eligibility assessment, 30 patients were eventually randomized and enrolled; finally, 15 patients in the vCBT and 14 patients in the TAU group were analyzed. Although no significant difference was found between the 2 groups in terms of changes in pain intensity by the numerical rating scale scores at week 16 from baseline (P=.36), there was a significant improvement in the comprehensive evaluation of pain by total score of Brief Pain Inventory (–1.43, 95% CI –2.49 to –0.37, df=24; P=.01). Further, significant improvement was seen in pain interference by using the Brief Pain Inventory (–9.42, 95% CI –14.47 to –4.36, df=25; P=.001) and in disability by using the Pain Disability Assessment Scale (–1.95, 95% CI –3.33 to –0.56, df=24; P=.008) compared with TAU. As for the Medical Economic Evaluation, the incremental cost-effectiveness ratio for 1 year was estimated at 2.9 million yen (about US $25,000) per quality-adjusted life year gained. CONCLUSIONS The findings of our study suggest that integrated cognitive behavioral therapy delivered by videoconferencing in regular medical care may reduce pain interference but not pain intensity. Further, this treatment method may be cost-effective, although this needs to be further verified using a larger sample size. CLINICALTRIAL University Hospital Medical Information Network UMIN000031124; https://tinyurl.com/2pr3xszb

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Psychological support of patients with chronic pain on multidisciplinary management

Regional Anesthesia and Acute Pain Management ◽

10.17816/1993-6508-2020-14-4-206-216 ◽

2020 ◽

Vol 14 (4) ◽

pp. 206-216

Author(s):

Vladimir V. Khinovker ◽

M. V. Alkina ◽

P. A. Chernomurova ◽

A. A. Gazenkampf

Keyword(s):

Chronic Pain ◽

Back Pain ◽

Cognitive Behavioral Therapy ◽

Pain Intensity ◽

Chronic Back Pain ◽

Behavioral Therapy ◽

Self Regulation ◽

Psychological Support ◽

Support Program ◽

Cognitive Behavioral

Background. Although pain has been studied extensively, its treatment remains an urgent problem. Pain can be caused by various factors, both at the physiological and psychological levels. Patients with chronic pain develop specific psychological problems. Viewing pain through the prism of a psychosocial approach involves the use and development of new psychotechnologies. Objective. This study aimed to explore the possibilities of improving the emotional state and reducing pain intensity in patients with chronic back pain using mindfulness and cognitive behavioral therapy techniques. Materials and methods. The study sample consisted of 30 patients with chronic back pain (20 women, 10 men) who were on outpatient treatment at a pain management center. Results and discussion. Based on the results of the analysis and generalization of literature sources, we prepared a psychological support program, including cognitive behavioral and mindfulness techniques. The program consisted of three blocks: diagnostics, exercises, and repeat diagnostics. Experimental data have shown the possibility and confirmed the effectiveness of reducing levels of depression, anxiety, and pain. Conclusions. Patients with chronic pain often present with varying levels of depression and anxiety symptoms and a reduced quality of life. A medical and psychological support program using mindfulness techniques and cognitive behavioral therapy positively influenced the level of anxiety, depression, and pain intensity. A medical and psychological support program helped patients learned methods of self-regulation and self-relaxation.

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Clinical Effectiveness and Cost-effectiveness of Videoconference-Based Integrated Cognitive Behavioral Therapy for Chronic Pain: Randomized Controlled Trial

Journal of Medical Internet Research ◽

10.2196/30690 ◽

2021 ◽

Vol 23 (11) ◽

pp. e30690

Author(s):

Kayoko Taguchi ◽

Noriko Numata ◽

Rieko Takanashi ◽

Ryo Takemura ◽

Tokiko Yoshida ◽

...

Keyword(s):

Chronic Pain ◽

Cognitive Behavioral Therapy ◽

Pain Intensity ◽

Rating Scale ◽

Numerical Rating Scale ◽

Behavioral Therapy ◽

Controlled Trial ◽

Brief Pain Inventory ◽

Cognitive Behavioral ◽

Pain Interference

Background Cognitive behavioral therapy is known to improve the management of chronic pain. However, the components of this therapy are still being investigated and debated. Objective This study aimed to examine the effectiveness of an integrated cognitive behavioral therapy program with new components (attention-shift, memory work, video feedback, and image training) delivered via videoconferencing. Methods This study was unblinded and participants were recruited and assessed face-to-face in the outpatient department. We conducted a randomized controlled trial for chronic pain to compare 16 weekly videoconference-based cognitive behavioral therapy (vCBT) sessions provided by a therapist with treatment as usual (TAU). Thirty patients (age range, 22-75 years) with chronic pain were randomly assigned to either vCBT (n=15) or TAU (n=15). Patients were evaluated at week 1 (baseline), week 8 (midintervention), and week 16 (postintervention). The primary outcome was the change in pain intensity, which was recorded using the numerical rating scale at 16 weeks from the baseline. Secondary outcomes were pain severity and pain interference, which were assessed using the Brief Pain Inventory. Additionally, we evaluated disability, pain catastrophizing cognition, depression, anxiety, quality of life, and cost utility. Results In the eligibility assessment, 30 patients were eventually randomized and enrolled; finally, 15 patients in the vCBT and 14 patients in the TAU group were analyzed. Although no significant difference was found between the 2 groups in terms of changes in pain intensity by the numerical rating scale scores at week 16 from baseline (P=.36), there was a significant improvement in the comprehensive evaluation of pain by total score of Brief Pain Inventory (–1.43, 95% CI –2.49 to –0.37, df=24; P=.01). Further, significant improvement was seen in pain interference by using the Brief Pain Inventory (–9.42, 95% CI –14.47 to –4.36, df=25; P=.001) and in disability by using the Pain Disability Assessment Scale (–1.95, 95% CI –3.33 to –0.56, df=24; P=.008) compared with TAU. As for the Medical Economic Evaluation, the incremental cost-effectiveness ratio for 1 year was estimated at 2.9 million yen (about US $25,000) per quality-adjusted life year gained. Conclusions The findings of our study suggest that integrated cognitive behavioral therapy delivered by videoconferencing in regular medical care may reduce pain interference but not pain intensity. Further, this treatment method may be cost-effective, although this needs to be further verified using a larger sample size. Trial Registration University Hospital Medical Information Network UMIN000031124; https://tinyurl.com/2pr3xszb

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