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Subcortical resting state connectivity in patients with chronic pain explains and predicts treatment response to exposure In Vivo treatment

Exposure in Vivo (EXP) appears to be a successful treatment for people with chronic pain. However, does this apply to every chronic pain patient or is it possible to predict who will benefit most from EXP? This presentation attempts to provide an answer to this question.

By examining resting state functional connectivity (rs-FC) in a group of patients with chronic pain undergoing EXP treatment it can be concluded that: 1) prior to treatment, patients showed decreased rs-FC between the hippocampus and vmPFC, dlPFC and precuneus compared to controls, 2) treatment modulated rs-FC between right hippocampus and left frontal pole (dlPFC), and 3) pre-EXP rs-FC strength between NAc and sensorimotor areas, and amygdala and superior frontal gyrus predicted which patients would show a clinically relevant reduction in pain intensity or pain catastrophizing versus those who would not, indicating potential prognostic value. Taken together, this findings clearly delineate the importance of cortico-limbic connectivity in chronic pain and in the response to EXP treatment.

Workshop: Exposure in Vivo for chronic pain: the latest insights to optimize success

Exposure in Vivo is a form of cognitive behavioral therapy in which pain patients systematically investigate and refute their anxious expectations about movement and pain as an expression of damage. While the emphasis within the Exposure in Vivo was previously on the decrease of anxiety, according to the latest insights it is important to consider the mismatch between the anxious expectation of the pain patient and the actual outcome of an exposure exercise. This workshop focuses on what this means for practice.

During the workshop you will learn about:

– The content of the exposure treatment

– The clinical importance to explicitly identify the patient’s expectations (movement / activity [CS] > pain as an expression of damage [US] relationship) during the diagnostic phase. What is the central “if CS … then US” expectation?

– The experienced decrease in anxiety during and between exposure sessions has no significant relationship with the final therapy result and therefore does not deserve any explicit focus in therapy (for example by monitoring the anxiety); the decrease in anxiety is a side effect.

– The contexts in which the patient obtains disconfirmative information play a decisive role during exposure therapy.

– Make a well-considered decision about safety behavior.

Jeroen de Jong

  • Dr. Jeroen de Jong (JdJ) is a cognitive behavioural therapist VGCT® / movement scientist / pain therapist / senior researcher in the field of behavioural medicine and rehabilitation medicine.

  • Within this position JdJ developed current outpatient rehabilitation for chronic pain and unexplained physical complaints.

  • Research activities included the development and psychometric analysis of pain assessment instruments, laboratory studies focusing on the role of pain-related fear and stress, and clinical trials and single-case studies (N=1) examining differential effectiveness of cognitive-behavioral treatments in patients with chronoic pain.

  • JdJ is recognized as the founder of the Exposure in Vivo therapy in chronic pain.

  • Currently, research is also focused on the mechanism behind the success of Exposure in Vivo by means of fMRI studies.

  • JdJ has an active role in the education of behaviour medicine at Maastricht University (Medicine, Mental Health, Psychology).

  • JdJ  is developing a vlog about pain. The vlog will be broadcast weekly via social media. The purpose of the vlog is to discuss myths and misunderstandings about pain.

Jeroen de Jong

  • Dr. Jeroen de Jong (JdJ) is a cognitive behavioural therapist VGCT® / movement scientist / pain therapist / senior researcher in the field of behavioural medicine and rehabilitation medicine.

  • Within this position JdJ developed current outpatient rehabilitation for chronic pain and unexplained physical complaints.

  • Research activities included the development and psychometric analysis of pain assessment instruments, laboratory studies focusing on the role of pain-related fear and stress, and clinical trials and single-case studies (N=1) examining differential effectiveness of cognitive-behavioral treatments in patients with chronoic pain.

  • JdJ is recognized as the founder of the Exposure in Vivo therapy in chronic pain.

  • Currently, research is also focused on the mechanism behind the success of Exposure in Vivo by means of fMRI studies.

  • JdJ has an active role in the education of behaviour medicine at Maastricht University (Medicine, Mental Health, Psychology).

  • JdJ  is developing a vlog about pain. The vlog will be broadcast weekly via social media. The purpose of the vlog is to discuss myths and misunderstandings about pain.

Subcortical resting state connectivity in patients with chronic pain explains and predicts treatment response to exposure In Vivo treatment

Exposure in Vivo (EXP) appears to be a successful treatment for people with chronic pain. However, does this apply to every chronic pain patient or is it possible to predict who will benefit most from EXP? This presentation attempts to provide an answer to this question.

By examining resting state functional connectivity (rs-FC) in a group of patients with chronic pain undergoing EXP treatment it can be concluded that: 1) prior to treatment, patients showed decreased rs-FC between the hippocampus and vmPFC, dlPFC and precuneus compared to controls, 2) treatment modulated rs-FC between right hippocampus and left frontal pole (dlPFC), and 3) pre-EXP rs-FC strength between NAc and sensorimotor areas, and amygdala and superior frontal gyrus predicted which patients would show a clinically relevant reduction in pain intensity or pain catastrophizing versus those who would not, indicating potential prognostic value. Taken together, this findings clearly delineate the importance of cortico-limbic connectivity in chronic pain and in the response to EXP treatment.

Workshop: Exposure in Vivo for chronic pain: the latest insights to optimize success

Exposure in Vivo is a form of cognitive behavioral therapy in which pain patients systematically investigate and refute their anxious expectations about movement and pain as an expression of damage. While the emphasis within the Exposure in Vivo was previously on the decrease of anxiety, according to the latest insights it is important to consider the mismatch between the anxious expectation of the pain patient and the actual outcome of an exposure exercise. This workshop focuses on what this means for practice.

During the workshop you will learn about:

– The content of the exposure treatment

– The clinical importance to explicitly identify the patient’s expectations (movement / activity [CS] > pain as an expression of damage [US] relationship) during the diagnostic phase. What is the central “if CS … then US” expectation?

– The experienced decrease in anxiety during and between exposure sessions has no significant relationship with the final therapy result and therefore does not deserve any explicit focus in therapy (for example by monitoring the anxiety); the decrease in anxiety is a side effect.

– The contexts in which the patient obtains disconfirmative information play a decisive role during exposure therapy.

– Make a well-considered decision about safety behavior.