Mind-body (including meditation and yoga)
Secondary Topic: Basic Science
Brain mechanisms underlying symptom improvement in chronic visceral pain after mindfulness training
Kirsten Tillisch, MD, UCLA, Los Angeles, CA, United States; Lisa Kilpatrick, PhD, , LOS ANGELES, CA, United States; Ravi Bhatt, PhD, UCLA, LOS ANGELES, CA, United States; Jennifer Labus, PhD; Annie Gupta, PhD, , LOS ANGELES, CA, United States; Cody Ashe-McNalley, MS, UCLA, LOS ANGELES, CA, United States; Jean Stains, RN; Suzanne Smith, NP, , LOS ANGELES, CA, United States; Greg Serpa, PhD, Greater Los Angeles VA, LOS ANGELES, CA, United States; Bruce Naliboff, PhD, , LOS ANGELES, CA, United States
Late Breaker: No
Background: Irritable Bowel Syndrome (IBS) is a brain-gut disorder characterized by abdominal pain associated with altered bowel habits which responds well to Mind-body interventions, such as hypnosis, cognitive behavioral therapy and Mindfulness Based Stress Reduction (MBSR). Aims: To determine symptom-related changes in resting state network connectivity (RS-FC) in patients with IBS after a MBSR intervention.
Methods: Men and women aged 18-55 years completed structural and resting state fMRI scans before and after a standard MBSR intervention. Participants completed questionnaires before and after the intervention, including the Mindful Attention Awareness Scale (MAAS) and the IBS-Severity Scoring System (IBS-SSS). Structural images were segmented and parceled into 165 regions based on Destrieux and Harvard-Oxford atlases and the functional connectivity between regions was calculated. Network analysis via graph theory was applied, focusing on regions involved in emotional processing (amygdala, medial prefrontal cortex), somatosensory processing (postcentral and subcentral gyri), and salience (insula, anterior cingulate cortex).
Results: A total of 63 participants (47 women; mean age, 33±9.8 years; age range, 19-54 years) completed the MBSR training and scans. Treatment-related improvement in IBS-SSS was observed (mean improvement, 74.8 points, p<0.001), which was significantly correlated with treatment-related improvement in MAAS (r=0.27, p=0.039). IBS-SSS improvement was significantly correlated with treatment-related decreases in the connectivity strength of the left amygdala (r=0.39, p=0.002, q=.039), right subcentral gyrus; (r=0.30, p=0.016, q=.15), and left suborbital gyrus/sulcus (medial prefrontal cortex; r=0.37, p=0.003, q=.039), and with treatment-related decreases in the eigenvector centrality of the left suborbital gyrus/sulcus (r=0.38, p=0.002, q=.039). Treatment-related decrease in the connectivity strength of the left suborbital gyrus/sulcus was also correlated with improvements in MAAS (r=.036, p=0.004).
Conclusion: IBS patients undergoing an MBSR intervention have improvements in mindfulness and overall IBS symptoms, which are associated with decreases in the strength and centrality of emotional processing, somatosensory, and salience brain regions.