The objectives of this study are to identify neural mechanisms of increased pain in pediatric FAPD and examine mechanisms of disrupted attention in the presence of induced pain. The overarching goal is to determine whether youth with FAPD process pain differently than healthy youth and to identify the brain areas involved.
The goal of the current project is to enhance understanding of the neural mechanisms associated with the pain experience in youth with functional abdominal pain disorders (FAPD), which is the most common and debilitating presentation of FAPD. This study will examine the neural mechanisms associated with pain induction and diminished attentional regulation during pain in FAPD. Findings from pilot studies indicate that increased anxiety in FAPD is associated with higher pain-related impairment, and that anxiety may adversely impact response to a cognitive behavioral intervention for pain. While pain outcomes improve when anxiety is also addressed in treatment for FAPD, a sizable portion fail to respond to currently available interventions. Further, the PI found that induced pain in FAPD is associated with changes in regional brain activity and functional connectivity between brain regions that are implicated in chronic pain. It is crucial to better understand the neural mechanisms which may place youth with FAPD at risk for poorer outcomes in order to ultimately develop more effective treatments. In this study, neural mechanisms of response to a pain symptom provocation task in youth with FAPD will be compared to healthy controls. The impact of anxiety levels will also be explored. This study will also examine neural mechanisms associated with disrupted attentional regulation during pain induction in youth with FAPD.
Study Type
OBSERVATIONAL
All children will receive a functional magnetic resonance imaging (fMRI) scan, where they will complete some preliminary scans while completing two cognitive tasks, and then be removed from the scanner to complete a water loading symptom provocation task (WL-SPT). After the WL-SPT task, they will resume the fMRI scan and complete additional cognitive tasks to assess for diminished attentional regulation. Measures of pain intensity, pain unpleasantness, and state anxiety will be obtained throughout.
Cincinnati Children's Hospital Medical Center
Cincinnati, Ohio, United States
Neural Mechanisms During Pain Induction
Amygdala-Prefrontal Cortex (AMY-PFC) functional connectivity will be enhanced following WL-SPT in the FAPD group vs HC. Increased brain activity and functional connectivity will correspond to higher pain in FAPD.
Time frame: Approximately 1.5 hours
Attentional Regulation During Cognitive Task
Functional connectivity between the AMY-PFC will be enhanced during a cognitive task, which will be related to higher pain ratings and response time.
Time frame: Approximately 30 minutes
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