Differences in brain structure and function in older adults with self-reported disabling and nondisabling chronic low back pain

Pain Medicine (United States)

Volumn 11, Issue 8, 2010, Pages 1183-1197

  Buckalew, Neilly ^b   Haut, Marc W ^c   Aizenstein, Howard ^a,b   Morrow, Lisa ^a   Perera, Subashan ^a   Kuwabara, Hiroto ^e   Weiner, Debra K ^a,d  

^a UNIVERSITY OF PITTSBURGH SCHOOL OF MEDICINE   (United States)

^b UNIVERSITY OF PITTSBURGH   (United States)

^c WEST VIRGINIA UNIVERSITY SCHOOL OF MEDICINE   (United States)

^d VETERANS AFFAIRS MEDICAL CENTER   (United States)

^e Johns Hopkins   (United States)

Author keywords

Chronic pain; Disability; Functional MRI; Older adults; Structural MRI

Indexed keywords

ADULT; AGED; ARTICLE; BRAIN; CHRONIC DISEASE; CROSS-SECTIONAL STUDY; DISABLED PERSON; FEMALE; HISTOLOGY; HUMAN; LOW BACK PAIN; MALE; NEUROPSYCHOLOGICAL TEST; NUCLEAR MAGNETIC RESONANCE IMAGING; PAIN ASSESSMENT; PATHOPHYSIOLOGY; PILOT STUDY;

ADULT; AGED; AGED, 80 AND OVER; BRAIN; CHRONIC DISEASE; CROSS-SECTIONAL STUDIES; DISABLED PERSONS; FEMALE; HUMANS; LOW BACK PAIN; MAGNETIC RESONANCE IMAGING; MALE; NEUROPSYCHOLOGICAL TESTS; PAIN MEASUREMENT; PILOT PROJECTS;

EID: 79952115321     PISSN: 15262375     EISSN: 15264637     Source Type: Journal    
DOI: 10.1111/j.1526-4637.2010.00899.x     Document Type: Article

References (126)

1. Edmond SL, Felson DT. Prevalence of backS symptoms in elders. J Rheumatol 2000;27:220-5.
2. Helme RD, Gibson SJ. The epidemiology of pain in elderly people. Clin Geriatr Med 2001;17:417-31.
3. Weiner DK, Haggerty CL, Kritchevsky SB, et al. How does low back pain impact physical function in independent, well-functioning older adults? Evidence from the Health ABC Cohort and implications for the future. Pain Med 2003;4:311-20.
4. Di Iorio A, Abate M, Guralnik JM, et al. From chronic low back pain to disability, a multifactorial mediatedpathway: The InCHIANTI study. Spine 2007;32: E809-15.
5. Edmond SL, Felson DT. Function and back symptoms in older adults. J Am Geriatr Soc 2003;51: 1702-9.
6. Ettinger WH, Fried LP, Harris T, et al. Self-reported causes of physical disability in older people: The Cardiovascular Health Study. J Am Geriatr Soc 1994;42: 1035-44.
7. Inzitari M, Newman AB, Yaffe K, et al. Gait speed predicts decline in attention and psychomotor speed in older adults: The health aging and body composition study. Neuroepidemiology 2007;29:156-62.
8. Leveille SG, Guralnik JM, Hochberg M, et al. Low back pain and disability in older women: Independent association with difficulty but not inability to perform daily activities. J Gerontol Med Sci 1999;54:M487- 93.
9. Reid MC, Guo Z, Towle VR, Kerns RD, Concato J. Factors associated with pain-related disability among older male veterans receiving primary care. J Gerontol Med Sci 2002;57:M727-32.
10. Weiner DK, Rudy TE, Glick RM, et al. Efficacy of percutaneous electrical nerve stimulation (PENS) for the treatment of chronic low back pain in older adults. J Am Geriatr Soc 2003;51:599-608.
11. Weinstein JN, Tosteson TD, Lurie JD, et al.; SPORT Investigators. Surgical versus nonsurgical therapy for lumbar spinal stenosis. N Engl J Med 2008;358:794.
12. Gill TM, Williams CS, Richardson ED, Tinetti ME. Impairments in physical performance and cognitive status as predisposing factors for functional dependence among nondisabled older persons. J Gerontol Med Sci 1996;51:M283-8.
13. Guralnik JM, Ferrucci L, Pieper CF, et al. Lower extremity function and subsequent disability: Consistency across studies, predictive models, and value of gait speed alone compared with the short physical performance battery. J Gerontol A Biol Sci Med Sci 2000;55:M221-31.
14. Guralnik JM, Ferrucci L, Simonsick EM, Salive ME, Wallace RB. Lower-extremity function in persons over the age of 70 years as a predictor of subsequent disability. N Engl J Med 1995;332:556-61.
15. Onder G, Penninx BW, Ferrucci L, et al. Measures of physical performance and risk for progressive and catastrophic disability: Results from the Women's Health and Aging Study. J Gerontol A Biol Sci Med Sci 2005;60:74-9.
16. Rosano C, Newman AB, Katz R, Hirsch CH, Kuller LH. Association between lower digit symbol substitution test score and slower gait and greater risk of mortality and of developing incident disability in wellfunctioning older adults. J Am Geriatr Soc 2008; 56:1618-25.
17. Weiner DK, Rudy TE, Morrow L, Slaboda J, Lieber S. The relationship between pain, neuropsychological performance, and physical function in communitydwelling older adults with chronic low back pain. Pain Med 2006;7:60-70.
18. Buckalew N, Haut MW, Morrow L, Weiner D. Chronic pain is associated with brain volume loss in older adults: Preliminary evidence. Pain Med 2008;9: 240-8.
19. May A. Chronic pain may change the structure of the brain. Pain 2008;137:7-15.
20. Peyron R, Laurent B, García-Larrea L. Functional imaging of brain responses to pain. A review and meta-analysis 20. Neurophysiol Clin 2000;30:263- 88.
21. Collins SL, Moore RA, McQuay HJ. The visual analogue pain intensity scale: What is moderate pain in millimeters? Pain 1997;72:95-7.
22. Weiner D, Pieper C, McConnell E, Martinez S, Keefe F. Pain measurement in elders with chronic low back pain: Traditional and alternative approaches. Pain 1996;67:461-7.
23. Reid MC,Williams CS, Gill TM. Back pain and decline in lower extremity physical function among community-dwelling older persons. J Gerontol A Biol Sci Med Sci 2005;60:793-7.
24. Schmidt R, Launer LJ, Nilsson LG, et al. Magnetic resonance imaging of the brain in diabetes: The cardiovascular determinant of dementia (CASCADE) study. Diabetes 2004;53:687-92.
25. Taylor WD, MacFall JR, Payne ME, et al. Greater lesion volumes in elderly depressed subjects than in control subjects. Psychiatry Res 2005;139:1-7.
26. Hayano F, Nakamura M, Asami T, et al. Smaller amygdala is associated with anxiety in patients with panic disorder. Psychiatry Clin Neurosci 2009;63: 266-76.
27. Shah SG, Klumpp H, Angstadt M, Nathan PJ, Phan KL. Amygdala and insula response to emotional images in patients with generalized social anxiety disorder. J Psychiatry Neurosci 2009;34:296-302.
28. Villarreal G, Hamilton DA, Graham DP, et al. Reduced area of the corpus callosum in posttraumatic stress disorder. Psychiatry Res Neuroimaging 2004;131: 227-35.
29. Bleecker ML, Bolla-Wilson K, Kawas C, Agnew J. Age-specific norms for the Mini-Mental State Exam. Neurology 1988;38(10):1565-8.
30. Folstein MF, Folstein S, McHugh PR. Mini-mental state: A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975;12:189-98.
31. Raz N, Rodrigue KM, Acker JD. Hypertension and the brain: Vulnerability of the prefrontal regions and executive functions. Behav Neurosci 2003;117: 1169-80.
32. Melzack R. The short-form McGill pain questionnaire. Pain 1987;30:191-7.
33. Parmelee PA, Thuras PD, Katz IR, Lawton MP. Validation of the Cumulative Illness Rating Scale in a geriatric residential population. J Am Geriatr Soc 1995;43:130-7.
34. Linn BS, Linn MW, Gurel L. Cumulative illness rating scale. J Am Geriatr Soc 1968;16:622-6.
35. Apkarian AV, Sosa Y, Sonty S, et al. Chronic back pain is associated with decreased prefrontal and thalamic gray matter density. J Neurosci 2004;24: 10410-5.
36. Tisserand DJ, Pruessner JC, Argita EJS, et al. Regional frontal cortical volumes decrease differentially in aging: An MRI study to compare volumetric approaches and voxel-based morphometry. Neuroimage 2002;17:657-69.
37. Haut MW, Kuwabara H, Ducatman AM, et al. Corpus callosum volume in railroad workers with chronic exposure to solvents. J Occup Environ Med 2006; 48:615-24.
38. Raz N, Gunning FM, Head D, et al. Selective aging of the human cerebral cortex observed in vivo: Differential vulnerability of the prefrontal gray matter. Cerebral Cortex 1997;7:268-82.
39. Benedetti B, Charil A, Rovaris M, et al. Influence of aging on brain gray and white matter changes assessed by conventional, MT, and DT MRI. Neurology 2006;66:535-9.
40. Basser P, Mattiello J, Le Bihan D. Estimation of the effective self-diffusion tensor from the NMR spin echo. J Magn Reson 1994;103:47-54.
41. Basser P, Mattiello J, Le Bihan D. MR diffusion tensor spectroscopy and imaging. Biophys J 1994;66:259- 67.
42. Basser P, Pierpaoli C. Microstructural and physiological features of tissues elucidated by quantitativediffusion-tensor MRI. JMR B 1996;111:209-19.
43. Pierpaoli C, Barnett A, Pajevic S, et al. Water diffusion changes in Wallerian degeneration and their dependence on white matter architecture. Neuroimage 2001;13:1174-85.
44. Sorensen AG, Wu O, Copen WA, et al. Human acute cerebral ischemic: Detection of changes in water diffusion anisotropy by using MR imaging. Radiology 1999;212:785-92.
45. Thomalla G, Glauche V, Koch MA, et al. Diffusion tensor imaging detects early wallerian degeneration of the pyramidal tract after ischemic stroke. Neuroimage 2004;22:1767-74.
46. Werring D, Toosy A, Clark C, et al. Diffusion tensor imaging can detect and quantify corticospinal tract degeneration after stroke. J Neurol Neurosurg Pschiat 2000;69:269-72.
47. Pfefferbaum A, Sullivan EV, Hedehus M, et al. Agerelated decline in brain white matter anisotropy measured with spatially corrected echo-planar diffusion tensor imaging. Magn Reson Med 2000;44:259-68.
48. Sullivan EV, Adalsteinsson E, Hedehus J, et al. Equivalent disruption of regional white matter microstructure in ageing healthy men and women. NeuroReport 2001;12:99-104.
49. Salat DH, Tuch DS, Greve DN, et al. Age-related alterations in white matter microstructure measured by diffusion tensor imaging. Neurobiol Aging 2005; 26:1215-27.
50. Buckner R, Vincent J. Unrest at rest: Default activity and spontaneous network correlations. Neuroimage 2007;37:1091-6, discussion 7-9.
51. Raichle M, Snyder A. A default mode of brain function: A brief history of an evolving idea. Neuroimage 2007;37:1083-90, discussion 97-9.
52. Raichle M, MacLeod A, Snyder A, et al. A default mode of brain function. Proc Natl Acad Sci USA 2001;98:676-82.
53. Auer D. Spontaneous low-frequency blood oxygenation level-dependent fluctuations and functional connectivity analysis of the resting brain. Magn Reson Imaging 2008;26:55-64.
54. Mazoyer B, Zago L, Mellet E, et al. Cortical networks for working memory and executive functions sustain the conscious resting state in man. Brain Res Bull 2001;54:287-98.
55. Lowe MJ, Mock BJ, Sorenson JA. Functional connectivity in single and multislice echoplanar imaging using resting-state fluctuations. Neuroimage 1998;7: 119-32.
56. Tzourio-Mazoyer N, Landeau B, Papathanassiou D, et al. Automated anatomical labeling of activations in SPM using a macroscopic anatomical parcellation of the MNI MRI single-subject brain. Neuroimage 2002;15:273-89.
57. Laird AR, Fox PM, Price CJ, et al. ALE meta-analysis: Controlling the false discovery rate and performing statistical contrasts. Hum Brain Mapp 2005;25:155- 64.
58. Lancaster JL, Woldorff MG, Parsons LM, et al. Automated Talairach Atlas labels for functional brain mapping. Hum Brain Mapp 2000;10:120-31.
59. Crawford J. Current and premorbid intelligence measures in neuropsychological assessment. In: Crawford JR, Parker DM, McKinlay WW, eds. A Handbook of Neuropsychological Assessment. Hillsdale, NJ: Lawrence Erlbaum Associates; 1992:21-50.
60. Randolph C, Tierney M, Mohr E, Chase TN. The Repeatable Battery for the Assessment of Neuropsychological Status (RBANS): Preliminary clinical validity. J Clin Exp Neuropsychol 1998;20:310-9.
61. Tombaugh TN. Trail Making Test A and B: Normative data stratified by age and education. Arch Clin Neuropsychol 2004;19:203-14.
62. Lemay S, Bédard MA, Rouleau I, Tremblay PL. Practice effect and test-retest reliability of attentional and executive tests in middle-aged to elderly subjects. Clin Neuropsychol 2004;18:284-302.
63. Guralnik JM, Simonsick EM, Ferrucci L, et al. A short physical performance battery assessing lower extremity function: Association with self-reported disability and prediction of mortality and nursing home admission. J Gerontol Med Sci 1994;49:M85-94.
64. Studenski S, Perera S, Wallace D, et al. Physical performance measures in the clinical setting. J Am Geriatr Soc 2003;51:314-22.
65. Rosano C, Simonsick EM, Harris TB, et al., Newman AB for the Health, Aging and Body Composition Research Group. Association between physical and cognitive function in healthy elderly: The Health, Aging and Body Composition Study. Neuroepidemiology 2005;24:8-14.
66. Schmidt-Wilcke T, Leinisch E, Straube A, et al. Gray matter decrease in patients with chronic tension type headache. Neurology 2005;65(9):1483-6.
67. Kuchinad A, Schweinhardt P, Seminowicz DA, et al. Accelerated brain gray matter loss in fibromyalgia patients: Premature aging of the brain? J Neurosci 2007;27(15):4004-7.
68. Teutsch S, Herken W, Bingel U, Schoell E, May A. Changes in brain gray matter due to repetitive painful stimulation. Neuroimage 2008;42:845-9.
69. Bingel U, Schoell E, Herken W, Büchel C, May A. Habituation to painful stimulation involves the antinociceptive system. Pain 2007;131:21-30.
70. Albanese MC, Duerden EG, Rainville P, Duncan GH. Memory traces of pain in human cortex. J Neurosci 2007;27:4612-20.
71. Duncan GH, Albanese MC. Is there a role for the parietal lobes in the perception of pain? Adv Neurol 2003;93:69-86.
72. Sawamoto N, Honda M, Okada T, et al. Expectation of pain enhances responses to nonpainful somatosensory stimulation in the anterior cingulate cortex and parietal operculum/posterior insula: An eventrelated functional magnetic resonance imaging study. J Neurosci 2000;20:7438-45.
73. Apkarian AV, Darbar A, Krauss BR, Gelnar PA, Szeverenyi NM. Differentiating cortical areas related to pain perception from stimulus identification: Temporal analysis of fMRI activity. J Neurophysiol 1999;81: 2956-63.
74. Casey KL, Minoshima S, Berger KL, et al. Positron emission tomographic analysis of cerebral structures activated specifically by repetitive noxious heat stimuli. J Neurophysiol 1994;71:802-7.
75. Talbot JD, Marrett S, Evans AC, et al. Multiple representations of pain in human cerebral cortex. Science 1991;251:1355-8.
76. Peyron R, Garcia-Larrea L, Gregoire MC, et al. Parietal and cingulate processes in central pain. A combined positron emission tomography (PET) and functional magnetic resonance imaging (fMRI) study of an unusual case. Pain 2000;84:77-87.
77. Schmahmann JD, Leifer D. Parietal pseudothalamic pain syndrome. Clinical features and anatomic correlates. Arch Neurol 1992;49:1032-7.
78. Geha PY, Baliki MN, Harden RN, et al. The brain in chronic CRPS pain: Abnormal gray-white matter interactions in emotional and autonomic regions. Neuron 2008;60:570-81.
79. Raz N, Rodrigue KM, Acker JD. Hypertension and the brain: Vulnerability of the prefrontal regions and executive functions. Behav Neurosci 2003;117: 1169-80.
80. Ballmaier M, Kumar A, Elderkin-Thompson V, et al. Mapping callosal morphology in early- and late-onset elderly depression: An index of distinct changes in cortical connectivity. Neuropsychopharmacology 2008;33:1528-36.
81. Karp JF, Rudy TE, Weiner DK. Persistent pain biases item response on the geriatric depression scale: Preliminary evidence for validity of the GDS-PAIN. Pain Med 2008;9:33-43.
82. Hartvigsen J, Frederiksen H, Christensen K. Physical and mental function and incident low back pain in seniors: A population-based two-year prospective study of 1387 Danish Twins aged 70 to 100 years. Spine 2006;31:1628-32.
83. Reid MC, Williams CS, Concato J, Tinetti ME, Gill TM. Depressive symptoms as a risk factor for disabling back pain in community-dwelling older persons. J Am Geriatr Soc 2003;51:1710-7.
84. McNamara P, Stavitsky K, Harris E, Szent-Imrey O, Durso R. Mood, side of motor symptom onset and pain complaints in Parkinson's disease. Int J Geriatr Psychiatry 2010;25:519-24.
85. Hari R, Portin K, Kettenmann B, Jousmäki V, Kobal G. Right hemisphere preponderance of responses to painful CO2 stimulation of the human nasal mucosa. Pain 1997;72:145-51.
86. Hsieh JC, Hannerz J, Ingvar M. Right lateralized central processing for pain of nitroglycerin-induced cluster headache. Pain 1996;67:59-68.
87. Neri M, Agazzani E. Aging and right-left asymmetry in experimental pain measurement. Pain 1984;19:43- 8.
88. Derbyshire SW, Jones AK. Cerebral responses to a continual tonic pain stimulus measured using positron emission tomography. Pain 1998;76:127- 35.
89. Hsieh JC, Belfrage M, Stone-Elander S, Hansson P, Ingvar M. Central representation of chronic ongoing neuropathic pain studied by positron emission tomography. Pain 1995;63:225-36.
90. Iadarola MJ, Berman KF, Zeffiro TA, et al. Neural activation during acute capsaicin-evoked pain and allodynia assessed with PET. Brain 1998;121:931- 47.
91. Edwards-Lee TA, Saul R. Neuropsychiatry of the right frontal lobe. In: Miller BL, Cummings L, eds. The Human Frontal Lobes: Functions and Disorders. New York: The Guilford Press; 1991:304-20.
92. Schiffer F, Teicher MH, Papanicolaou AC. Evoked potential evidence for right brain activity during recall of traumatic memories. J Neuropsychiatry 1995;7: 169-75.
93. Goldin PR, McRae K, Ramel W, Gross JJ. The neural bases of emotion regulation: Reappraisal and suppression of negative emotion. Biol Psychiatry 2008; 63:577-86.
94. Phan KL, Fitzgerald DA, Nathan PJ, et al. Neural substrates for voluntary suppression of negative affect: A functional magnetic resonance imaging study. Biol Psychiatry 2005;57:210-9.
95. Sommer M, Döhnel K, Sodian B, et al. Neural correlates of true and false belief reasoning. Neuroimage 2007;35:1378-84.
96. Bermpohl F, Pascual-Leone A, Amedi A, et al. Attentional modulation of emotional stimulus processing: An fMRI study using emotional expectancy. Hum Brain Mapp 2006;27:662-77.
97. Geyer S. The microstructural border between the motor and the cognitive domain in the human cerebral cortex. Adv Anat Embryol Cell Biol 2004;174:I- VIII, 1-89.
98. Porter R. The Kugelberg lecture. Brain mechanisms of voluntary motor commands: A review. Electroencephalogr Clin Neurophysiol 1990;76:282-93.
99. Rizzolatti G, Luppino G, Matelli M. The organization of the cortical motor system: New concepts. Electroencephalogr Clin Neurophysiol 1998;106:283-96.
100. Matsuzaka Y, Aizawa H, Tanji J. A motor area rostral to the supplementary motor area (presupplementary motor area) in the monkey: Neuronal activity during a learned motor task. J Neurophysiol 1992;68:653-62.
101. Roland PE, Larsen B, Lassen NA, Skinhoj E. Supplementary motor area and other cortical areas in organization of voluntary movements in man. J Neurophysiol 1980;43:118-36.
102. Shima K, Tanji J. Both supplementary and presupplementary motor areas are crucial for the temporal organization of multiple movements. J Neurophysiol 1998;80:3247-60.
103. Davis H IV, Liotti M, Ngan ET, et al. fMRI BOLD signal changes in elite swimmers while viewing videos of personal failure. Brain Imaging Behav 2008;2:84-93.
104. Gamsa A. The role of psychological factors in chronic pain. A half century of study. Pain 1994;57:5-15.
105. Wright J, Morley S. Autobiographical memory and chronic pain. Br J Clin Psychol 1995;34:255-65.
106. Blair KS, Smith BW, Mitchell DG, et al. Modulation of emotion by cognition and cognition by emotion. Neuroimage 2007;35:430-40.
107. Rosano C, Branch J, Longstreth WT, Newman AB. Quantitative measures of gait characteristics indicate prevalence of underlying subclinical structural brain abnormalities in higher-functioning older adults. Neuroepidemiology 2006;26:52-60.
108. Rosano C, Kuller LH, Chung H, et al. Subclinical brain magnetic resonance imaging abnormalities predict physical functional decline in high-functioning older adults. J Am Geriatr Soc 2005;53:649-54.
109. Sachdev PS, Wen W, Christensen H, Jorm AF. White matter hyperintensities are related to physical disability and poor motor function. J Neurol Neurosurg Psychiatry 2005;76:362-7.
110. Wolfson L, Wei X, Hall CB, et al. Accrual of MRI white matter abnormalities in elderly with normal and impaired mobility. J Neurol Sci 2005;232:23-7.
111. Starr JM, Leaper SA, Murray AD, et al. Brain white matter lesions detected by magnetic resonance [correction of resonance] imaging are associated with balance and gait speed. J Neurol Neurosurg Psychiatry 2003;74:94-8.
112. Whitman GT, Tang Y, Lin A, Baloh RW. A prospective study of cerebral white matter abnormalities in older people with gait dysfunction. Neurology 2001;57: 990-4.
113. Atkinson HH, Rosano C, Simonsick EM, et al. Cognitive function, gait speed decline, and comorbidities: The health, aging and body composition study. J Gerontol A Biol Sci Med Sci 2007;62:844-50.
114. Johnson JK, Lui LY, Yaffe K. Executive function, more than global cognition, predicts functional decline and mortality in elderly women. J Gerontol A Biol Sci Med Sci 2007;62:1134-41.
115. Royall DR, Chiodo LK, Mouton C, Polk MJ. Cognitive predictors of mortality in elderly retirees: Results from the freedom house study. Am J Geriatr Psychiatry 2007;15:243-51.
116. Lavery LL, Starenchak SM, Flynn WB, et al. The clock drawing test is an independent predictor of incident use of 24-hour care in a retirement community. J Gerontol A Biol Sci Med Sci 2005;60A:928- 32.
117. Pennix BWJH, Ferrucci L, Leveille SG, et al. Lower extremity performance in nondisabled older persons as a predictor of subsequent hospitalization. J Gerontol Med Sci 2000;55A:M691-7.
118. Resnick NM, Marcantonio ER. How should clinical care of the aged differ? Lancet 1997;350:1157-8.
119. Lunde LH, Nordhus IH, Pallesen S. The effectiveness of cognitive and behavioural treatment of chronic pain in the elderly: A quantitative review. J Clin Psychol Med Settings 2009;16:254-62.
120. Smeets RJ, Vlaeyen JW, Kester AD, Knottnerus JA. Reduction of pain catastrophizing mediates the outcome of both physical and cognitive-behavioral treatment in chronic low back pain. J Pain 2006; 7:261-71.
121. Ostelo RW, van Tulder MW, Vlaeyen JW, et al. Behavioural treatment for chronic low-back pain. Cochrane Database Syst Rev 2005;(1): CD002014.
122. Reid MC, Otis J, Barry LC, Kerns RD. Cognitivebehavioral therapy for chronic low back pain in older persons: A preliminary study. Pain Med 2003;4:223- 30.
123. Middaugh SJ, Pawlick K. Biofeedback and behavioral treatment of persistent pain in the older adult: A review and a study. Appl Psychophysiol Biofeedback 2002;27:185-202.
124. Cipher DJ, Fernandez E, Clifford AP. Costeffectiveness and health care utilization in a multidisciplinary pain center: Comparison of three treatment groups. J Clin Psychol Med Settings 2001;8:237-44.
125. Orme-Johnson DW, Schneider RH, Son YD, Nidich S, Cho ZH. Neuroimaging of meditation's effect on brain reactivity to pain. Neuroreport 2006;17:1359- 63.
126. Morone NE, Greco CM, Weiner DK. Mindfulness meditation for the treatment of chronic low back pain in older adults: A randomized controlled pilot study. Pain 2008;134:310-9.