Journal of Clinical Sleep Medicine ( IF 4.3 ) Pub Date : 2021-07-26 , DOI: 10.5664/jcsm.9540 Christina S McCrae 1 , Jason G Craggs 2, 3 , Ashley F Curtis 1, 3 , Neetu Nair 1 , Daniel Kay 4 , Roland Staud 5 , Richard B Berry 6 , Michael E Robinson 7
Study Objectives:
To examine whether cognitive behavioral treatments for insomnia (CBT-I) and pain (CBT-P) lead to neural activation changes in response to pain in fibromyalgia.
Methods:
32 fibromyalgia patients (Mage=55.9, SD=12.2) underwent an experimental pain protocol during functional magnetic resonance imaging (fMRI) and completed 14-daily diaries assessing total wake time (TWT), total sleep time (TST), and pain intensity before and after CBT-I, CBT-P or waitlist control (WLC). Random effects ANCOVA identified regions with significant group (CBT-I, CBT-P, WLC) by time (baseline, post-treatment) interactions in blood oxygen level dependent (BOLD) response to pain. Linear regressions using residualized change scores examined how changes in TWT, TST, and pain intensity were related to activation (BOLD) changes.
Results:
12 regions exhibited significant interactions (ps<.00; small-moderate effects; right hemisphere: inferior frontal, middle occipital, and superior temporal gyri, insula, lentiform nucleus; left hemisphere: angular, superior temporal, mid-frontal, inferior occipital, mid-temporal, and inferior frontal gyri). BOLD response to pain decreased in 8 regions following CBT-I, and in 3 regions following CBT-P (CBT-I effects>CBT-P). BOLD response also increased in 3 regions following CBT-P and in 6 regions following WLC. Improved TWT and/or TST, not pain intensity, predicted decreased BOLD in 7 regions (ps<.05), accounting for 18-47% of the variance.
Conclusions:
CBT-I prompted greater decreases in neural activation in response to pain across more regions associated with pain and sleep processing than CBT-P. Reported sleep improvements may underlie those decreases. Future research examining the longer-term impact of CBT-I and improved sleep on central pain and sleep mechanisms is warranted.
Clinical Trial Registration:
Registry: ClinicalTrials.gov; Title: Sleep and Pain Interventions in Fibromyalgia (SPIN); Identifier: NCT02001077; URL: https://clinicaltrials.gov/ct2/show/NCT02001077
中文翻译:
对合并纤维肌痛和失眠患者进行认知行为治疗后,神经激活对疼痛的反应发生变化:一项初步研究
学习目标:
检查失眠 (CBT-I) 和疼痛 (CBT-P) 的认知行为治疗是否会导致神经激活变化以响应纤维肌痛中的疼痛。
方法:
32 名纤维肌痛患者(M年龄 = 55.9,SD = 12.2)在功能性磁共振成像(f MRI)期间接受了实验性疼痛方案,并完成了 14 天评估总清醒时间(TWT)、总睡眠时间(TST)和疼痛的日记CBT-I、CBT-P 或候补名单控制 (WLC) 前后的强度。随机效应 ANCOVA 通过时间(基线、治疗后)对疼痛的血氧水平依赖性(BOLD)反应的相互作用确定了具有显着组(CBT-I、CBT-P、WLC)的区域。使用残差变化分数的线性回归检验了 TWT、TST 和疼痛强度的变化如何与激活 (BOLD) 变化相关。
结果:
12 个区域表现出显着的相互作用(ps<.00;中小效应;右半球:额下回、枕中回和颞上回、脑岛、豆状核;左半球:角、颞上、额中、枕下、颞中回和额下回)。CBT-I 后的 8 个区域和 CBT-P 后的 3 个区域对疼痛的 BOLD 反应降低(CBT-I 效应 > CBT-P)。CBT-P 之后的 3 个地区和 WLC 之后的 6 个地区的 BOLD 反应也有所增加。改进的 TWT 和/或 TST,而不是疼痛强度,预测 7 个区域的 BOLD 降低 (ps<.05),占方差的 18-47%。
结论:
与 CBT-P 相比,CBT-I 促使更多与疼痛和睡眠处理相关的区域对疼痛做出反应的神经激活减少。报告的睡眠改善可能是这些减少的基础。未来有必要研究 CBT-I 和改善睡眠对中枢性疼痛和睡眠机制的长期影响。
临床试验注册:
登记处:ClinicalTrials.gov;标题:纤维肌痛的睡眠和疼痛干预 (SPIN);标识符:NCT02001077;网址:https://clinicaltrials.gov/ct2/show/NCT02001077