Pediatric Neural Changes to Physical and Emotional Pain After Intensive Interdisciplinary Pain Treatment: A Pilot Study

Abstract

Brain areas activated during pain can contribute to enhancing or reducing the pain experience, showing a potential connection between chronic pain and the neural response to pain in adolescents and youth. This study examined changes in brain activation associated with experiencing physical pain, and the observation of physical and emotional pain in others, by using functional magnetic resonance imaging (fMRI) before and after intensive interdisciplinary pain treatment (IIPT). Eighteen youth (age 14 to 18) with widespread chronic pain completed fMRI testing before and after IIPT to assess changes in brain activation in response to physical and emotional pain. Broadly, brain activation changes were observed in frontal, somatosensory, and limbic regions. These changes suggest improvements in descending pain modulation via thalamus and caudate, and the different pattern of brain activation after treatment suggests better discrimination between physical and emotional pain. Brain activation changes were also correlated with improvements in clinical outcomes of catastrophizing (reduced activation in right caudate, right mid-cingulate, and postcentral gyrus) and pain-related disability (increased activation in precentral gyrus, left hippocampus, right middle occipital cortex, and left superior frontal gyrus). These changes support interpretation that reduced brain protective responses to pain were associated with treatment-related improvements. This pilot study highlights the need for larger trials designed to better understand the brain mechanisms involved in pediatric widespread pain treatment.

Keywords: Pediatric pain; brain; catastrophizing; fear of pain; functional MRI; intensive interdisciplinary pain treatment.

Figure 1

A. Line graphs of each participant’s Pre and Post IIPT program scores for the Pain Related Cognitions Questionnaire for Children (PRCQ-C) Catastrophizing subscale and the Functional Disability Inventory (FDI). Nearly all participants’ Catastrophizing and Disability improved after the program. ** = p<.01; *** = p<.001. B. Correlations between change in Catastrophizing and Disability scores and change in brain activation during each task: sensory filament pain experience (left panel), viewing physical pain pictures (middle panel), and viewing emotional pain pictures (right panel). Clusters exceeding the statistical threshold for significance of voxel-wise p<.01 and a cluster size more than 25 contiguous voxels are indicated in red indicating positive correlation. The experience of physical pain, viewing physical pain, and viewing emotional pain were all associated with improvements in Catastrophizing and Disability, and were positively correlated with reductions in activation in different brain networks: experience of pain in sensorimotor cortex; viewing physical pain in frontal cortex; and viewing emotional pain in frontal cortex, motor cortex, anterior cingulate, and anterior insula.