Control over brain activation and pain learned by using real-time functional MRI

1. Control over brain activation and pain learned by using real-time functional MRI R.C. deCharms, F. Maeda, G.H. Glover, D. Ludlow, J.M. Pauly, D. Soneji, J.D.E. Gabrieli, and S.C. Mackey By Jennifer Wong

2. Introduction • Can learn control of autonomic measures – heart rate, skin conductance- and EEG rhythms • Pain perception affected by placebo effects, anticipation, attention • Subregions within rostral anterior cingulate cortex (rACC) are involved in pain perception • Hypnosis and placebos alter rACC and reduce pain perception • Broodman Area: 32/24

3. Introduction • Real-time fMRI measures localized processes as they occur

4. Research Question Can subjects learn to control the brain's system, and whether learned control over rACC activation would alter pain perception in healthy subjects and patients with chronic pain? Hypothesis Learned manipulation of rACC using real-time fMRI leads to decreased effects of pain perception

5. Methods • healthy community volunteers-20 Males, 16 Females • Chronic pain- 8 Males, 4 Females • peltier thermode on left palm • Individually selected temperatures with 7/10 pain rating Strategy instructions 1. Attention. Attend toward perceived stimulus vs. away from it. 2. Stimulus Quality. Perception as neutral experience vs. tissue damaging , overwhelming 3. Stimulus Severity. Perceive stimulus as low or high intensity 4. Control. Attempt to control painful experience.

6. Methods • Localizer scan, 3 training runs, post-test run • Chronic pain patients chose when to end scanning • Training/ post-test runs • Training rates stimulus after scan completed • Post-test rates stimulus immediately after receiving pain

7. Methods • Experimental: continuous video depicting activation, and scrolling line chart -% BOLD signal change over time (s) • Control: • Pain only- effects of repeated practice • Behavioural training, 2x longer, overt attention on pain • Shown a different region of the brain • rtfMRI of previously tested subject's rACC • Patient control: autonomic biofeedback – told to control skin conductance, Heart rate, respiration

8. Results A: change in activation comparing last to first training session B: post-test compared with first training session

9. Results Control over fMRI bold activation in rACC increased significantly Control over Pain increased significantly

10. Results MPQ: Mcgill pain questionaire VAS visual analogue scale 1-10:

11. Discussion • rACC: important for pain perception and regulation • Associated with cognitive processes: attention, emotion, task difficulty, motor control • Chronic pain patients need to be able to see functions of brain to control • Stronger pain control -> greater likelihood of successful recovery

12. Discussion • Limitations: subjects engaged brain regions associated with rACC • placebo effects are mediated in part by brains control system • Pain matrix involved with processing: ACC, somatosensory cortices, insula, thalamus • Pain anticipation Future Studies • Long term pain treatment • Type of patients show greatest response

13. Take Home Message • real-time fMRI was used to guide training to control rACC • rACC: subregions involved with mediating conscious pain perception • Increased Activation of rACC decreases pain perception • Experimental subjects (rtfMRI) decreased pain significantly more compared to control subjects

14. My Opinion Strengths Weaknesses • Easy to follow instructions in procedure • Good use of images and graphs • Interesting topic • Hard to understand the details in the statistical analysis and results • Small sample size of chronic pain patients