The Impact of Opioids on Chronic Pain: Clinical Research and Career Training in Spinal Cord fMRI and Brain Reward Systems

项目概要/摘要 虽然阿片类药物被规定用于治疗纤维肌痛引起的慢性疼痛，但对阿片类药物的科学理解仍然存在。 阿片类药物对中枢神经系统（CNS）活动和奖赏行为的影响 是有限的。目前的证据有力地表明，大脑和脊髓活动的改变 有助于纤维肌痛症状的慢性化，阿片类药物在 中枢神经系统活动。为了确定阿片类药物对纤维肌痛中枢神经系统活动的纵向影响， 该提案包括建立在初步研究基础上的临床神经成像研究项目 Martucci博士在其获奖的K99阶段完成的培训。 在她的奖项的R 00独立研究阶段，Martucci博士将进行 纤维肌痛患者的纵向临床研究，包括阿片类药物依赖和阿片类药物依赖， 幼稚，以确定慢性疼痛、伴随症状和CNS活动的变化 随着时间的推移与纤维肌痛疾病进展有关，无论是在存在还是不存在。 继续使用阿片类药物。 研究的目的将通过两个项目进行。项目#1将扩大初步研究 研究纤维肌痛患者的颈脊髓活动和阿片类药物的作用 纵向研究（1年以上）。项目#2将扩大初步研究调查 奖励行为和大脑奖励系统以及阿片类药物对患者的影响 纤维肌痛纵向研究（超过1年）。这些项目的其他目标将是 在一个大型独立的纤维肌痛队列中重复初始结果（来自K99期） 来自美国不同地区的患者，并确定 参与者的人口统计学和社会经济地位对纤维肌痛症状，脊髓 活动，奖励处理和阿片类药物的影响。 总之，这些项目将提供一个更完整的图片的神经生理学影响 阿片类药物治疗纤维肌痛，并将填补与潜在风险相关的关键知识空白 神经生物学的变化和改变的心理和行为， 开阿片类药物

Project Summary / Abstract Although opioids are prescribed for chronic pain due to fibromyalgia, scientific understanding of the effects of opioid medications on central nervous system (CNS) activity and reward behavior is limited. Current evidence strongly suggests that altered brain and spinal cord activity contributes to the chronicity of fibromyalgia symptoms, and opioids produce similar changes in CNS activity. To determine the longitudinal effects of opioids on CNS activity in fibromyalgia, the proposal includes clinical neuroimaging research projects that build upon preliminary research and training completed by Dr. Martucci during the K99 phase of her award. During the R00 independent research phase of her award, Dr. Martucci will conduct a longitudinal clinical research study of fibromyalgia patients, both opioid-dependent and opioid- naïve, to determine how changes in chronic pain, accompanying symptoms, and CNS activity over time relate to fibromyalgia disease progression both in the presence of and not in the presence of continued opioid use. The study aims will be conducted via two projects. Project #1 will extend preliminary research investigating cervical spinal cord activity and the effects of opioids in patients with fibromyalgia in a longitudinal study (over 1 year). Project #2 will extend preliminary research investigating reward behavior and brain reward systems and the effects of opioids in patients with fibromyalgia in a longitudinal study (over 1 year). Additional goals of the projects will be to replicate initial findings (from the K99 phase) in a large and independent cohort of fibromyalgia patients from a different region of the United States and to identify potential influences of participant demographics and socioeconomic status on fibromyalgia symptoms, spinal cord activity, reward processing, and opioid effects. Together, these projects will provide a more complete picture of the neurophysiological effects of opioid medications in fibromyalgia and will fill critical knowledge gaps related to potential risks of neurobiological changes and altered psychology and behavior that may occur when prescribing opioids.