UVM Theses and Dissertations
Format:
Print
Author:
Lieberman, Gregory
Dept./Program:
Neuroscience Graduate Program
Year:
2014
Degree:
Ph. D.
Abstract:
In addition to peripheral nerves and spinal pathways, pain perception relies heavily on a complex system of brain networks that encompass cognitive, emotional, and somatosensory circuits. Because of this central involvement in the pathology of chronic pain, many chronic pain patients find psychotherapeutic interventions such as cognitive behavioral therapy (CBT) to be helpful in coping with their symptoms and reducing pain severity. There is ample evidence that musculoskeletal pain is associated with measurable anatomical and functional abnormalities in the gray matter of the brain. However, not much is known about the role played by neural white matter in chronic pain, and even less has been published regarding the role of white matter in chronic musculoskeletal pain, specifically. We predicted that chronic musculoskeletal pain patients would exhibit white matter abnormalities within the pathways of the pain matrix as compared to a sample of healthy volunteers. Further, we predicted that these abnormalities would be correlated with severity of clinical outcomes.
No research has yet been presented that investigates the role of white matter neuroplasticity in recovery from chronic pain following clinical intervention. Cognitive behavioral therapy for coping with chronic pain is geared mainly toward developing new behavioral patterns and changing the way that patients think and feel about their pain and its negative impact on their lives. Studies have shown that learning new behaviors and practicing new skills (e.g. juggling, mindfulness, a second language) alters the properties of the brain's white matter. Because successful cognitive behavioral therapy depends on utilization of new skills and behaviors, we predicted that measurable changes would occur in the white matter connections between regions of the pain matrix after eleven weeks of therapy and at-home practice of new coping skills. Identifying how the properties of neural white matter are affected by chronic musculoskeletal pain pathology and recovery will offer insight into why some people develop chronic pain when others do not, and help us to better understand the mechanisms by which psychotherapeutic interventions improve clinical outcomes.
In this series of studies, we used diffusion tensor imaging to demonstrate that patients with chronic musculoskeletal pain exhibit abnormal metrics of white matter integrity as compared to healthy controls within fibers that convey information about the somatosensory, cognitive, and emotional components of chronic pain, as well as within motor circuits. The magnitude of several abnormal white matter differences also correlated with the severity of chronic pain-related clinical outcomes. Further, after an eleven-week regimen of cognitive behavioral therapy for coping with chronic pain, changes occurred in white matter integrity in several important tracts. A number of these changes also correlated with improvements in a patient-reported measure of pain selfefficacy, a predictor of chronic pain prognosis. Because these post-therapy changes do not reflect attenuation of baseline abnormalities, it is likely that they are the result of new behaviors and cognitive approaches to coping with pain rather than reversal ofchronic pain-related neuropathology.
No research has yet been presented that investigates the role of white matter neuroplasticity in recovery from chronic pain following clinical intervention. Cognitive behavioral therapy for coping with chronic pain is geared mainly toward developing new behavioral patterns and changing the way that patients think and feel about their pain and its negative impact on their lives. Studies have shown that learning new behaviors and practicing new skills (e.g. juggling, mindfulness, a second language) alters the properties of the brain's white matter. Because successful cognitive behavioral therapy depends on utilization of new skills and behaviors, we predicted that measurable changes would occur in the white matter connections between regions of the pain matrix after eleven weeks of therapy and at-home practice of new coping skills. Identifying how the properties of neural white matter are affected by chronic musculoskeletal pain pathology and recovery will offer insight into why some people develop chronic pain when others do not, and help us to better understand the mechanisms by which psychotherapeutic interventions improve clinical outcomes.
In this series of studies, we used diffusion tensor imaging to demonstrate that patients with chronic musculoskeletal pain exhibit abnormal metrics of white matter integrity as compared to healthy controls within fibers that convey information about the somatosensory, cognitive, and emotional components of chronic pain, as well as within motor circuits. The magnitude of several abnormal white matter differences also correlated with the severity of chronic pain-related clinical outcomes. Further, after an eleven-week regimen of cognitive behavioral therapy for coping with chronic pain, changes occurred in white matter integrity in several important tracts. A number of these changes also correlated with improvements in a patient-reported measure of pain selfefficacy, a predictor of chronic pain prognosis. Because these post-therapy changes do not reflect attenuation of baseline abnormalities, it is likely that they are the result of new behaviors and cognitive approaches to coping with pain rather than reversal ofchronic pain-related neuropathology.