Real-time fMRI applied to pain management

Department of Anesthesia, Stanford University, Palo Alto, CA, United States.
Neuroscience Letters (Impact Factor: 2.03). 03/2012; 520(2):174-81. DOI: 10.1016/j.neulet.2012.02.076
Source: PubMed


Current views recognize the brain as playing a pivotal role in the arising and maintenance of pain experience. Real-time fMRI (rtfMRI) feedback is a potential tool for pain modulation that directly targets the brain with the goal of restoring regulatory function. Though still relatively new, rtfMRI is a rapidly developing technology that has evolved in the last 15 years from simple proof of concept experiments to demonstrations of learned control of single and multiple brain areas. Numerous studies indicate rtfMRI feedback assisted control over specific brain areas may have applications including mood regulation, language processing, neurorehabilitation in stroke, enhancement of perception and learning, and pain management. We discuss in detail earlier work from our lab in which rtfMRI feedback was used to train both healthy controls and chronic pain patients to modulate anterior cingulate cortex (ACC) activation for the purposes of altering pain experience. Both groups improved in their ability to control ACC activation and modulate their pain with rtfMRI feedback training. Furthermore, the degree to which participants were able to modulate their pain correlated with the degree of control over ACC activation. We additionally review current advances in rtfMRI feedback, such as real-time pattern classification, that bring the technology closer to more comprehensive control over neural function. Finally, remaining methodological questions concerning the further development of rtfMRI feedback and its implications for the future of pain research are also discussed.

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    • "The authors also transferred their design to chronic pain patients who subsequently reported pain relief. However, a replication of these results is still missing (Chapin et al., 2012). We (Rance et al., 2014) previously examined and compared the effect of separately up-and downregulating two regions that are part of the pain processing network: the rACC, involved in the tonic aversive state elicited by pain (Apkarian et al., 2005; Qu et al., 2011) and the left posterior insula (pInsL), a region that processes the sensory aspect of pain perception (Rainville et al., 1997; Frot et al., 2007). "
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    ABSTRACT: The aim of this study was the analysis of the effect of a learned increase in the dissociation between the rostral anterior cingulate cortex (rACC) and the left posterior insula (pInsL) on pain intensity and unpleasantness and the contribution of each region to the effect, exploring the possibility to influence the perception of pain with neurofeedback methods. We trained ten healthy subjects to increase the difference in the blood oxygenation level-dependent response between the rACC and pInsL to painful electric stimuli. Subjects learned to increase the dissociation with either the rACC (state 1) or the pInsL (state 2) being higher. For feedback we subtracted the signal of one region from the other and provided feedback in four conditions with six trials each yielding two different states: [rACC—pInsL increase (state 1), rACC—pInsL decrease (state 2), pInsL—rACC increase (state 2), pInsL—rACC decrease (state 1)]. Significant changes in the dissociation from trial one to six were seen in all conditions. There were significant changes from trial one to six in the pInsL in three of the four conditions, the rACC showed no significant change. Pain intensity or unpleasantness ratings were unrelated to the dissociation between the regions and the activation in each region. Learning success in the conditions did not significantly correlate and there was no significant correlation between the two respective conditions of one state, i.e., learning to achieve a specific state is not a stable ability. The pInsL seems to be the driving force behind changes in the learned dissociation between the regions. Despite successful differential modulation of activation in areas responsive to the painful stimulus, no corresponding changes in the perception of pain intensity or unpleasantness emerged. Learning to induce different states of dissociation between the areas is not a stable ability since success did not correlate overall or between two conditions of the the same state.
    Frontiers in Behavioral Neuroscience 10/2014; 8(357). DOI:10.3389/fnbeh.2014.00357 · 3.27 Impact Factor
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    • "There have since been substantial advancements related to rtfMRI technology and implementation (Hinds et al., 2011; LaConte, 2011; Weiskopf et al., 2005), with reports of rtfMRI modification of function in multiple brain structures, including auditory (Haller et al., 2010; Yoo et al., 2007), visual (Scharnowski et al., 2012; Shibata et al., 2011), and sensorimotor cortices (deCharms et al., 2004; Sitaram et al., 2012; Yoo and Jolesz, 2002), amygdala (Bruhl et al., 2014; Zotev et al., 2011; Zotev et al., 2013), insula (Caria et al., 2010; Caria et al., 2007; Frank et al., 2012), parahippocampal gyrus (Weiskopf et al., 2004; Yoo et al., 2012), anterior cingulate cortex (Chapin et al., 2012; deCharms et al., 2005; Li et al., 2013), and prefrontal cortex (Rota et al., 2009; Sitaram et al., 2011), among others. Several groups have reported successful application of rtfMRI to modify cognitive and behavioral processes relevant for the treatment of clinical disorders (for review of these studies see Birbaumer et al., 2009; Caria et al., 2012; Chapin et al., 2012; deCharms, 2007; deCharms, 2008; Sulzer et al., 2013; Weiskopf, 2012; Weiskopf et al., 2007). Studies have demonstrated promise of rtfMRI neurofeedback in the treatment of chronic pain (deCharms et al., 2005), tinnitus (Haller et al., 2010), stroke (Sitaram et al., 2012), depression (Linden et al., 2012), schizophrenia (Ruiz et al., 2013), obesity (Frank et al., 2012), and addiction (Hartwell et al., 2013). "
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    ABSTRACT: While reducing the burden of brain disorders remains a top priority of organizations like the World Health Organization and National Institutes of Health, the development of novel, safe and effective treatments for brain disorders has been slow. In this paper, we describe the state of the science for an emerging technology, real time functional magnetic resonance imaging (rtfMRI) neurofeedback, in clinical neurotherapeutics. We review the scientific potential of rtfMRI and outline research strategies to optimize the development and application of rtfMRI neurofeedback as a next generation therapeutic tool. We propose that rtfMRI can be used to address a broad range of clinical problems by improving our understanding of brain–behavior relationships in order to develop more specific and effective interventions for individuals with brain disorders. We focus on the use of rtfMRI neurofeedback as a clinical neurotherapeutic tool to drive plasticity in brain function, cognition, and behavior. Our overall goal is for rtfMRI to advance personalized assessment and intervention approaches to enhance resilience and reduce morbidity by correcting maladaptive patterns of brain function in those with brain disorders.
    Clinical neuroimaging 07/2014; 5. DOI:10.1016/j.nicl.2014.07.002 · 2.53 Impact Factor
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    • "Manipulating pain unpleasantness by hypnotic suggestion also changed the regional cerebral blood flow (rCBF) in the ACC, but not in the somatosensory cortex, providing evidence that the ACC is involved in the processing of pain-related affect, but not in the sensory processing of noxious stimulation (Rainville et al., 1997). In addition to hypnotic suggestion, real-time fMRI studies have shown that both healthy controls and chronic pain patients can be trained to decrease activity in the ACC for relief of pain, with greater " control " of neurofeedback corresponding to lower pain ratings (Chapin et al., 2012), although as "
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    ABSTRACT: The neural network that contributes to the suffering which accompanies persistent pain states involves a number of brain regions. Of primary interest is the contribution of the cingulate cortex in processing the affective component of pain. The purpose of this review is to summarize recent data obtained using novel behavioral paradigms in animals based on measuring escape and/or avoidance of a noxious stimulus. These paradigms have successfully been used to study the nature of the neuroanatomical and neurochemical contributions of the anterior cingulate cortex (ACC) to higher order pain processing in rodents.
    Frontiers in Integrative Neuroscience 05/2014; 8:35. DOI:10.3389/fnint.2014.00035
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