Exposure in vivo induced changes in neural circuitry for pain-related fear: A longitudinal fMRI study in chronic low back pain

Inge Timmers*, Jeroen R. de Jong, Mariëlle Goossens, Jeanine A. Verbunt, Rob J. Smeets, Amanda L. Kaas

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

4 Citations (Web of Science)

Abstract

Exposure in vivo (EXP) is a cognitive-behavioral treatment aimed at reducing pain-related fear in chronic pain, and has proven successful in reducing pain-related disability in patients with chronic low back pain (cLBP). The current longitudinal study aimed to reveal the neural correlates of changes in pain-related fear as a result of EXP. Twenty-three patients with cLBP were included in this study. Patients with cLBP underwent MRI scanning pre-treatment (pre-EXP), post-treatment (post-EXP), and 6 months after end of treatment (FU-EXP). Pain-free controls were scanned at two time points. In the scanner, participants were presented with pictures involving back-related movements, evoking pain-related fear in patients. Pre-treatment, functional MRI revealed increased activation in right posterior insula and increased deactivation in medial prefrontal cortex (mPFC) in patients compared to controls. Post-treatment, patients reported reduced fear and pre-EXP group differences were no longer present. Contrasting pre-to postand FU-EXP in patients revealed that stimulus-evoked neural responses changed in sensorimotor as well as cognitive/affective brain regions. Lastly, exploratory analyses revealed a tendency toward an association between changes in neural activation and changes in fear ratings, including the hippocampus and temporal lobe (pre-to post-EXP changes), and mPFC and posterior cingulate cortex (pre-to FU-EXP changes). Taken together, we show evidence that neural circuitry for pain-related fear is modulated by EXP, and that changes are associated with self-reported decreases in pain-related fear.

Original languageEnglish
Article number970
Number of pages18
JournalFrontiers in Neuroscience
Volume13
DOIs
Publication statusPublished - 17 Sep 2019

Keywords

  • chronic pain
  • exposure in vivo
  • neuroimaging
  • pain-related fear
  • rehabilitation
  • chronic low back pain
  • DORSOLATERAL PREFRONTAL CORTEX
  • INTRINSIC BRAIN CONNECTIVITY
  • FUNCTIONAL CONNECTIVITY
  • MOVEMENT (RE)INJURY
  • DISABILITY INDEX
  • EXTINCTION
  • AVOIDANCE
  • QUESTIONNAIRE
  • ABNORMALITIES
  • REDUCTION

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