Brain Function and Pain Interference after Pediatric Intensive Interdisciplinary Pain Treatment

Author:

Epp Spencer1,Walker Andrew1,Boudes Elodie2,Bray Signe3456,Noel Melanie45678,Rayner Laura1,Rasic Nivez167,Miller Jillian Vinall14567

Affiliation:

1. Anesthesiology, Perioperative & Pain Medicine, University of Calgary, Calgary, AB, Canada

2. Department of Pediatrics, Cumming School of Medicine, The University of Calgary, Calgary, Alberta, Canada

3. Department of Radiology, Cumming School of Medicine, The University of Calgary, Calgary, Alberta, Canada; Hotchkiss Brain Institute, Calgary, Alberta, Canada

4. ■■■■

5. Owerko Centre, Alberta Children’s Hospital Research Institute, Calgary, Alberta Canada

6. Alberta Children’s Hospital Research Institute, Calgary, Alberta, Canada

7. Vi Riddell Children’s Pain & Rehabilitation Centre, Alberta Children’s Hospital, Calgary, AB, Canada

8. Psychology, University of Calgary, Calgary, AB, Canada

Abstract

Background and Objectives: Intensive interdisciplinary pain treatments (IIPTs) are programs that aim to improve functioning in youth with severe chronic pain. Little is known about how the brain changes following IIPT, however, decreased brain responses to emotional stimuli have been identified previously in pediatric chronic pain relative to healthy controls. We examined whether IIPT increased brain responses to emotional stimuli, and whether this change was associated with a reduction in pain interference. Methods: Twenty youth with chronic pain aged 14-18 years were scanned using fMRI, pre- and post-IIPT. During the fMRI, patients were presented with emotional stimuli (i.e., faces expressing happiness/fear), neutral expressions, and control (i.e., scrambled) images. Patients completed a measure of pain interference pre- and post-IIPT. Paired t-tests were used to examine differences in brain activation in response to emotional versus neutral stimuli, pre- to post-IIPT. Data from significant brain clusters were entered into linear mixed models to examine the relationships between brain activation and impairment pre- and post-IIPT. Results: Patients demonstrated a decrease in middle frontal gyrus (MFG) activation in response to emotional stimuli (happy + fear) relative to scrambled images, between pre- and post-IIPT (P<0.05). Lower MFG activation was associated with lower pain interference, pre- and-post IIPT (P<0.05). Conclusion: Contrary to our hypothesis, IIPT was associated with a reduction in MFG activation to emotional stimuli, and this change was associated with reduced pain interference. The MFG is a highly interconnected brain area involved in both pain chronification and antinociception. With further validation of these results, the MFG may represent an important biomarker for evaluating patient treatment response and target for future pain interventions.

Publisher

Ovid Technologies (Wolters Kluwer Health)

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