Neuroimaging Mechanism of Cognitive Behavioral Therapy in Pain Management, 2022, Bao et al

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.

Open access, https://www.hindawi.com/journals/prm/2022/6266619/

 

Damn, New Phrenology sure is wild. Especially since obviously they are only imaging the effect of CBT, nothing else. Nothing else at all that could happen in a span of months, nope, nothing.

And of course as we know with chronic pain, it is constant and precise, it never, ever itself changes, so you know that you are only measuring how pain is perceived, never the actual pain, because we know its precise value at the start and that it never changes throughout. You know, since we can measure it precisely and reliably. Well, no we can't but let's imagine anyway. Imaging, imagining, almost the same thing, really.

Also TIL we can now image things like "cognitive reassessment" and "altered perception". I wonder when they'll image karma and other stuff.

Economics used to do a lot of silly stuff like this, especially behavioral economics. The concept of "rational consumer" was long central to microeconomics, that people make decisions rationally based on full information awareness. Then they realized that reality is far more complicated than models and accepted that models are just that, models. But that phase did last several decades so who knows how long will this nonsense last.

 

'Experts discover that looking at a blue cardigan for long periods shrinks your brain.'

 

From part of the discussion regarding some limitations:

They make a good point that improvement in insomnia for example could be key to a reduction in pain and point it out as a confounding factor.

I was looking for information on long-term follow up since people with chronic pain want the pain to be 'fixed' or 'cured' by a treatment ongoing into the future. There never seems to be any long-term follow up in these studies and if they are a separate paper I've never seen them here and I expect they'd get picked up.

This particular study was funded by Chinese National research and development.