Skip to main content

ORIGINAL RESEARCH article

Front. Pain Res.
Sec. Musculoskeletal Pain
Volume 5 - 2024 | doi: 10.3389/fpain.2024.1408027

Enhancing Chronic Low Back Pain Management: An Initial Neuroimaging Study of a Mobile Interoceptive Attention Training

Provisionally accepted
Irina Strigo Irina Strigo 1,2*Sergio G. Guerra Sergio G. Guerra 2Salvatore Torrisi Salvatore Torrisi 2Emily Murphy Emily Murphy 2Tiffany Toor Tiffany Toor 2Veronica Goldman Veronica Goldman 3Benedict Alter Benedict Alter 4An Vu An Vu 2Rich Hecht Rich Hecht 3Jeff Lotz Jeff Lotz 1Alan N. Simmons Alan N. Simmons 5Wolf E. Mehling Wolf E. Mehling 3
  • 1 University of California, San Francisco, San Francisco, United States
  • 2 San Francisco VA Health Care System, Veterans Health Administration, United States Department of Veterans Affairs, San Francisco, California, United States
  • 3 Osher Center for Integrative Health, Medical Center, University of California, San Francisco, San Francisco, California, United States
  • 4 University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
  • 5 VA San Diego Healthcare System, Veterans Health Administration, United States Department of Veterans Affairs, San Diego, California, United States

The final, formatted version of the article will be published soon.

    Chronic low back pain (cLBP) poses significant challenges, often addressed through avoidance or distraction. Emerging evidence suggests that mind-body interventions, like our novel Mind Your Pain (MyP) smartphone mobile application, may offer relief. We conducted a single-arm, mixedmethods neuroimaging study to assess the degree to which treatment response to our 8-week intervention, as measured by the reduction in the Pain, Enjoyment of Life and General Activity Scale (PEG), was associated with enhanced pain-related insula activation over time. Twenty-nine individuals with cLBP completed patient-reported assessments, qualitative sensory testing (QST) measures, and neuroimaging pre-and post-MyP. Functional MRI data during experimental heat pain on the left forearm were collected and analyzed, comparing responders (≥50% reduction in PEG scores) and non-responders. MyP led to significant decreases in PEG scores overall. Furthermore, MyP responders exhibited increased pain-related activation in key brain regions, including the contralateral posterior insula, bilateral ventral anterior insula, ventral anterior cingulate, dorsolateral prefrontal cortex, and nucleus accumbens. Although baseline behavioral and sensory measures did not differ between the two responder groups, baseline neural differences related to the impact of the endogenous back pain were observed. MyP appears to modify pain response and underlying neural circuitry, suggesting neural changes in interoception may serve as biomarkers for mind-body interventions in cLBP. This study highlights the potential of MyP as a novel approach for cLBP management, warranting further investigation.

    Keywords: Interoceptive Awareness, insula, Nucleus Accumbens, anticipation, mindfulness, MAIA

    Received: 27 Mar 2024; Accepted: 19 Aug 2024.

    Copyright: © 2024 Strigo, Guerra, Torrisi, Murphy, Toor, Goldman, Alter, Vu, Hecht, Lotz, Simmons and Mehling. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Irina Strigo, University of California, San Francisco, San Francisco, United States

    Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.