Author ORCID Identifier

https://orcid.org/0000-0001-7109-6466

Semester

Summer

Date of Graduation

2023

Document Type

Dissertation

Degree Type

PhD

College

School of Medicine

Department

Not Listed

Committee Chair

James Lewis

Committee Member

Victor Finomore

Committee Member

Randy Nelson

Committee Member

Richard Vaglienti

Committee Member

Matthew Dietz

Abstract

Chronic lower back pain (CLBP) is one of the leading causes of disability worldwide, with an estimated direct cost of over 600 billion dollars in the US alone. CLBP profoundly impacts the patient, their support team, and the healthcare system. Widespread changes to the patient's well-being, including mental health, are seen in CLBP and contribute to a downward spiral that often leads to disability. Chronic pain is poorly understood and is difficult to treat because of its subjective nature. Recent improvements in pain assessment in the clinic and in biomedical research have had a profoundly impacted the field. More than ever, there is a call for a more holistic approach to pain research, pain assessment, and pain treatment. In particular, the understanding that chronic pain is significantly more complicated that a localized insult to the system and that chronic pain treatment needs to encompass more than just pain amelioration. There is a litany of ongoing debate and investigation into the mechanism behind the development and potentiation of chronic pain. A key hallmark of CLBP is functional neural alteration. It is unclear whether these functional neural alterations are causative in CLBP or are a result thereof. More likely, they are delicately intertwined. A potential supplemental non-pharmacological treatment for CLBP is Restricted Environment Stimulation Therapy achieved through repeated flotation sessions in a sensory deprivation tank (REST flotation). REST flotation has been shown to reduce depressive and anxiety like symptoms in healthy adults, along with alterations to key networks associated with CLBP. To this end, I propose the following working hypothesis, that REST flotation is beneficial for patients who suffer from CLBP.

To investigate the effects of REST flotation on CLBP, we assessed twenty CLBP pain patients, who underwent six one-hour sessions in either a sensory deprivation tank (experimental) or a nappod (control). Primary assessments were resting-state functional magnetic resonance imaging (rs-fMRI), the cold pressor test, and a task-based fMRI. This assessment was supplemented by electroencephalogram (EEG) in a subpopulation chapter 6 at baseline and after six sessions.

In brief, I saw significant inter and intra-functional connectivity via rs-fMRI. Many of these changes observed in our sample are correlated with decreased CLBP in the literature. We also saw a significant increase in the time participants in the experimental group could withstand a noxious stimulus after REST flotation. It is important to note that there were no significant changes in back pain rating over time by either group. Lastly, we improved a task-based fMRI paradigm for the assessment of CLBP. There were no significant changes in behavioral reports from the task over time or by condition. However, there are significant data to validate the task. There was a significant difference between subjective pain ratings in response to active over neutral pain cues. In addition, several key regions of interest identified by previous investigations were also activated by the task. Whereas these data are preliminary, they show promise for supplemental nonpharmacological treatment for CLBP. Participants in the experimental group showed pain-associated improvements in both resting-state and task-based fMRI signatures compared to the control group. In addition, REST flotation improved intra-network connectivity of the salience network, which may explain the marked increase in the duration of noxious stimuli withstood.

Embargo Reason

Publication Pending

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