Correlations between brain changes and pain management after cognitive and meditative therapies: A systematic review of neuroimaging studies
Introduction
Pain was defined by the International Association for the Study of Pain (IASP) as an unpleasant sensory and emotional experience, associated with actual or potential tissue damage, or described in terms of such injuries.1 The World Health Organization (WHO) recognizes pain as an important global, public health concern. However, when pain becomes chronic, it has a strong impact on the patient's life and a high cost for the health system. In 2007, WHO identified a need for improved and standardized management of chronic pain (both malignant and non-malignant) and acute pain.2 Pain affects function, relationships, and behaviour and it is more than a sensory experience; it involves immune, endocrine, meaning making, emotional, and behavioral responses.3
Since psychosocial factors play important roles in pain and associated physical and psychosocial disability,4 patients and researchers on the pain field seek therapeutic approaches on pain management involving psychological strategies as such as cognitive and meditative therapies (CMT). CMT is an evidence-based psychotherapeutic method, rooted in behaviorism and cognitive psychological theory,5 Since the introduction of CMT for chronic pain more than 35 years ago,6,7 there have been many published reports of symptom improvements in patients with various forms of chronic pain.8,9,10 A systematic review and meta-analysis of randomised controlled trials (RCT’s) of CMT for fibromyalgia patients concluded that CMT improves coping with pain, reduces depressed mood and healthcare-seeking behaviour in such patients.11
Brain is a proven source of endogenous modulation of pain and brain imaging studies have contributed to the understanding of cerebral changes associated with chronic pain.12,13 Recent evidence of neuroimaging studies has established a connection between cognitive dysfunction and specific changes in brain structure14 and function.15 Evidence of neural networks that support such modulation has probably opened alternative pathways of treatment and CMT have demonstrated promising options for the multidisciplinar pain management. A better understanding of brain mechanisms underlying therapy can promote improvements in the therapeutic interventions as well as increase our knowledge on the formation and maintenance of symptoms.16
Treatments involving CMT have been well investigated by behavioral studies, but few randomized studies bring up the neurological mechanisms involved. This systematic review aimed to analyze the existing data on brain changes recruited throught CMT, including cognitive behavioral therapy, mindfulness and/or meditation, for clinical and/or experimental pain management detected through neuroimaging techniques and to identify the effects of CMT over clinical pain outcomes.
Section snippets
Methods
The protocol defined to this systematic review adhered to the recommendations proposed by the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) and the Cochrane Handbook for Systematic Reviews of Interventions.17,18 The review question was: “What is the neuroimaging evidence and neuromodulatory effects of CMT on pain management?” This current study has been registered at PROSPERO CRD42016046312.
http://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42016046312).
Studies description
Fig. 1 presents flow diagram summarizing the study selection process. The initial search identified a total of 1371 studies. From those, following removal of 112 duplicates, screening of titles and abstracts identified 63 potential studies. After a detailed review of full text of retrieved studies, final sample for analysis was composed of nine studies. The most prevalent reasons for study exclusion were a non-randomized clinical trial, treatment intervention other than meditation, mindfulness
Discussion
To our knowledge, this is the first image-based systematic review of fMRI or EEG studies assessing brain regions recruited through cognitive strategies for pain modulation. Among nine RCTs included in this review, eight studied experimental pain-induced brain activation in chronic pain population, including FM, or in healthy subjects, and one looked resting state functional activity in patients with chronic pain, all focusing on neural and behavioral modifications after cognitive strategies.
References (51)
- et al.
The use of functional neuroimaging to evaluate psychological and other non-pharmacological treatments for clinical pain
Neurosci Lett
(2012) - et al.
Towards a theory of chronic pain
Prog Neurobiol
(2009) - et al.
Investigation into the neural correlates of emotional augmentation of clinical pain
Neuroimage
(2008) - et al.
Executive function in chronic pain patients and healthy controls: different cortical activation during response inhibition in fibromyalgia
J Pain
(2011) - et al.
Unlearning chronic pain: a randomized controlled trial to investigate changes in intrinsic brain connectivity following cognitive behavioral therapy
NeuroImage Clin
(2014) - et al.
Cognitive behavioral therapy increases pain-evoked activation of the prefrontal cortex in patients with fibromyalgeia
Pain
(2012) - et al.
Cognitive-behavioral therapy increases prefrontal cortex gray matter in patients with chronic pain
J Pain
(2013) - et al.
The utility of cognitive coping strategies for altering pain perception: a meta-analysis
Pain
(1989) - et al.
The lateral prefrontal cortex mediates the hyperalgesic effects of negative cognitions in chronic pain patients
J Pain
(2015) - et al.
Functional imaging of brain responses to pain. A review and meta-analysis (2000)
Neurophysiol Clin Neurophysiol
(2000)
Is meditation associated with altered brain structure? A systematic review and meta-analysis of morphometric neuroimaging in meditation practitioners
Neurosci Biobehav Rev
Decision making in the chronic pain patient (and rodent): contribution of the orbitofrontal cortex
Pain
Pain modulation: expectation, opioid analgesia and virtual pain
Prog Brain Res
A non-elaborative mental stance and decoupling of executive and pain-related cortices predicts low pain sensitivity in zen meditators
Pain
A scale for rating the quality of psychological trials for pain
Pain
Core outcome measures for chronic pain clinical trials: IMMPACT recommendations
Pain
The chronic fatigue syndrome: a comprehensive approach to its definition and study. International Chronic Fatigue Syndrome Study Group [see comments]
Ann Intern Med
WHO normative guidelines on pain management report of a delphi study to determine the need for guidelines that should be developed by WHO
Religiousness and spirituality in fibromyalgia and chronic pain patients
Curr Pain Headache Rep
Diagnosis and treatment of low back pain: a joint clinical practice guideline from the american college of physicians and the american pain society
Ann Intern Med
Behavioral methods for chronic pain and illness
Pain
Behavioral concepts in the analysis of chronic pain syndromes
J Consult Clin Psychol
Psychological therapies for the management of chronic pain (excluding headache) in adults
Cochrane Database Syst Rev
Behavioural treatment for chronic low-back pain
Cochrane Database Syst Rev
Cognitive-behavioral therapy for individuals with chronic pain. Efficacy, innovations, and directions for research
Am Psychol
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