Abstract
Purpose. To review the recent neuroimaging studies on cognitive-behavioral therapy (CBT) for pain management, with the aim of exploring possible mechanisms of CBT. Recent Findings. Current studies can be divided into four categories, mixed pain, fibromyalgia, migraine, and experimental pain, based on the type of disease included, with the same or different changes of brain regions after CBT intervention. According to structural and functional MRI analyses, changes of brain gray matter volume, activation and deactivation of brain regions, and intrinsic connectivity between brain regions were observed after CBT sessions. The brain regions involved mainly included some areas related to cognitive and emotional regulation. After comparison, the DLPFC, OFC, VLPFC, PCC and amygdala were found to be recurrent in multiple studies and may be key regions for CBT intervention in pain management. In the treatment of mixed chronic pain, CBT may decrease the gray matter volume of DLPFC, reduce ICN connection of OFC within the DAN network, and increase fALFF of the PCC. For FM intervention, CBT may activate the bilateral OFC and VLPFC, while in migraine, only the right OFC, VLPFC, and DLPFC were found to be more activated after CBT. In addition, the differential action of the left and right amygdala has also been shown in the latest study of migraine. In heat-evoked pain, CBT may increase the deactivation of the PCC, the connectivity between the DMN and right VLPFC, while diminishing the deactivation of VLPFC. Summary. After CBT, the brain showed stronger top-down pain control, cognitive reassessment, and altered perception of stimulus signals (chronic pain and repeated acute pain). The DLPFC, OFC, VLPFC, PCC, and amygdala may be the key brain regions in CBT intervention of pain.
Highlights
Cognitive-behavioral therapy (CBT) came out in the 1960s, which is a structured psychotherapeutic intervention that targets maladaptive cognitive factors to reduce negative affect [1]
IFC between the basal ganglia (BG) network and right secondary somatosensory (S2) cortex increased, which was revealed to the decrease in pain symptoms (ρ −0.343, P 0.035) and the increase in other clinical results such as self-efficacy for pain management (ρ 0.574, P < 0.001) [50]
orbitofrontal cortex (OFC) and ventrolateral prefrontal cortex (VLPFC) had shown their importance in the mechanism of CBT for pain (CBT-P), which are adjacent to dorsolateral prefrontal cortex (DLPFC). e findings suggested that CBT may treat FM and migraine by activating the right or bilateral OFC and VLPFC
Summary
Cognitive-behavioral therapy (CBT) came out in the 1960s, which is a structured psychotherapeutic intervention that targets maladaptive cognitive factors to reduce negative affect [1]. Since it has been extensively used in the treatment of psychiatric disorders, such as depression, anxiety disorders, and personality disorders [2]. Numerous studies have demonstrated its application value in nonpsychiatric disorders, including irritable bowel syndrome, insomnia, and chronic pain conditions, such as migraine and fibromyalgia. E importance of nonpharmacological treatment of chronic pain has become increasingly significant due to problems such as addiction to painkillers. With the development of neuroimaging techniques, it has been increasingly used to conduct studies about CBT to explore the mechanisms of CBT for pain management.
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