At our Center, “Integrative” has a dual meaning. It refers to Integrative Pain Medicine, which represents a system of interdisciplinary health care that integrates physical, psychological, and social factors for preventive and therapeutic pain management. It also refers to Integrative Neuroimaging, whereby data collected with technologies such as Magnetic Resonance Imaging (MRI), Positron Emission Tomography (PET), and MagnetoEncephaloGraphy (MEG) are synergistically combined to enhance understanding of structure / function relationships in the central nervous system.
Click on the headings below to learn about CiPNI's different areas of research and methodology.
Integrative Pain Medicine (click below)
This traditional Chinese medical therapy dates back thousands of years and involves the insertion of very thin needles into specific bodily locations, which can then be stimulated manually by hand or with electrical current. Recent research has identified neurophysiological pathways supporting acupuncture, as well as suggested efficacy for several chronic pain disorders, and other chronic aversive symptoms such as nausea and itch.
Vitaly Napadow (PI) and Jessica Gerber (Clinical Research Program Manager) are themselves practicing acupuncturists, and CiPNI has been responsible for several studies investigating the mechanisms and efficacy of acupuncture. Visit the Napadow Lab Publications page to explore CiPNI's work on acupuncture.
Cognitive Behavioral Therapy (CBT)
This psychological therapy focuses on the identification of distorted thinking, modifying beliefs and changing behaviors. CBT has been shown reduce pain and pain-related negative affect/cognition in various pain disorders.
The 'COMFORT' study is an ongoing study at CiPNI examining the brain correlates of cognitive behavioral therapy for fibromyalgia. Click here for an example of CiPNI's publications on CBT, and check the Napadow Lab Publications page for our latest papers.
Respiratory-Gated Auricular Vagal Afferent Nerve Stimulation
This modified form of transcutaneous vagus nerve stimulation (tVNS), a neuromodulation therapy, reduces pain by stimulating vagus-innervated regions of the ear. The brainstem vagal input–output system operates in tune with respiration and thus tVNS can be optimized by synchronizing stimulation with respiratory events to improve the analgesic benefits of tVNS.
Spinal Manipulative Therapy (SMT)
This therapy, commonly practiced by chiropractors, physical therapists and other providers, uses manual interventions delivered to the spinal vertebrae (such as lumbar thrust/non-thrust maneuvers) to reduce pain and improve function in several pain disorders, such as chronic back pain.
Check back soon for more information on CiPNI's SMT study!
Integrative Neuroimaging (click below)
Arterial Spin Labeling (ASL)
This functional MRI technique tags blood in the carotid arteries and tracks its perfusion in the brain to infer regional cerebral blood flow as a precise marker of brain activation. Given its properties, ASL can be a powerful tool to image the brain correlates of chronic pain.
Stimulus- (or task-) related functional MRI (fMRI)
This commonly applied imaging modality uses endogenous contrast mechanisms (which depend on blood oxygenation, volume and flow) to infer brain activity associated with brain processing of specific tasks or stimuli. For instance, stimulus-related fMRI can be used to evaluate how chronic pain patients process experimental pain in the brain.
Functional Connectivity MRI (fcMRI)
fcMRI evaluates the strength of connections between different brain regions and can assess the impact of pain disorders on connectivity between specific brain regions, as well as whether different therapies normalize such connectivity.
Positron Emission Tomography (PET)
This imaging modality uses injected radioactive tracers to localize binding and to image a variety of processes in the body, including neurotransmission, or the expression of specific proteins. PET allows us to evaluate how pain changes the chemistry of the brain and body, and can be used to track the progression of certain disorders, and identify novel targets for pharmacological treatment.
Magnetic Resonance Spectroscopy (H-MRS)
This technique can be used to quantify the concentration of important metabolites in specific locations of the human brain. For instance, the concentration of excitatory and inhibitory neurotransmitters, such as glutamate and GABA, respectively, has been found to be altered in chronic pain patients.
Electromagnetic field fluctuations accompany neuronal activity in the brain, and this functional neuroimaging modality is used to assess temporal dynamics in brain function, such as in response to evoked experimental pain stimuli.
Techniques such as voxel based morphometry (VBM) and cortical thickness analyses can be used in conjunction with high resolution T1-weighted structural MRI images to investigate gray matter volume and thickness in different brain regions. White matter microstructure can be assessed with diffusion tensor imaging (DTI), which evaluates anisotropic water diffusion along white matter fiber tracts.