Central Sensitization and Sleep Disturbance as Predictors of Treatment Outcomes in Patients with Knee Osteoarthritis

中枢敏化和睡眠障碍作为膝骨关节炎患者治疗结果的预测因素

• 批准号: 10306938
• 负责人: Claudia Michelle Campbell
• 金额: $ 40.84万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-08-01 至 2025-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10306938
• 关键词: Address; Advocate; Affect; Ancillary Study; Body mass index; Caring; Clinical; Coping Skills; Degenerative polyarthritis; Diagnostic radiologic examination; Economic Burden; Effectiveness; Elderly; Equipment; Evaluation; Funding; Future; Goals; Heterogeneity; High Prevalence; Hyaluronic Acid; Hyperalgesia; Hypersensitivity; Impairment; Individual; Individual Differences; Injections; Injury; Intervention; Knee Osteoarthritis; Knee joint; Knowledge; Laboratories; Lead; Life Expectancy; Link; Literature; Longterm Follow-up; Maintenance; Measures; Modeling; Nerve; Nerve Block; Neuraxis; Nociception; Operative Surgical Procedures; Opioid; Outcome; Outcome Measure; Pain; Pain Disorder; Pain management; Patient Outcomes Assessments; Patients; Pattern; Peripheral; Persistent pain; Phase; Phenotype; Physical Function; Population; Procedures; Public Health; Questionnaires; Radiofrequency Interstitial Ablation; Randomized Controlled Trials; Reporting; Resources; Risk; Role; Selection for Treatments; Sensory; Severities; Shapes; Site; Sleep; Sleep Apnea Syndromes; Sleep Deprivation; Sleep disturbances; Sleeplessness; Societies; Sum; Symptoms; Testing; Time; Treatment outcome; behavioral pharmacology; central sensitization; chronic pain; chronic painful condition; clinical pain; compare effectiveness; design; disability; duloxetine; effective intervention; experience; functional disability; global health; improved; improved outcome; indexing; knee replacement arthroplasty; neurotransmission; opioid therapy; osteoarthritis pain; pain chronification; pain model; pain processing; parent project; patient response; patient subsets; poor sleep; precision medicine; predicting response; recruit; response; skills training; standard care; transmission process; treatment comparison; treatment response

PROJECT SUMMARY/ABSTRACT Knee osteoarthritis (KOA) is one of the leading causes of chronic pain and disability worldwide, affecting over 30% of older adults, and represents a major global health and economic burden to individuals and society. The rates of KOA have more than doubled in the past 70 years and continue to grow sharply, given increases in life expectancy and population BMI. Surgery is often used to treat KOA, but is associated with a high rate of persistent pain and is not a permanent solution. Numerous nonsurgical therapies have been advocated to treat pain in patients with KOA. A growing literature documents enhanced central nervous system pain processing, known as central sensitization (CS), which produces widespread sensitivity, among KOA patients. Sleep disturbance is associated with CS but imparts a terrible burden on patients suffering from pain in its own right. Both CS and sleep disturbance are hallmarks of various chronic pain conditions and important treatment considerations, with both independently being associated with the initiation and maintenance of pain and heightening pain severity . The parent project, which provides the platform for the current proposal, will evaluate behavioral, pharmacologic, and procedural interventions for KOA; a step-care model that allows for multiple treatment comparisons and phenotyping to improve selection for each therapy, which is expected to refine outcomes and reduce unnecessary interventions. The results of this study, which will follow pragmatic principles in order to maximize the information provided to stakeholders, will address not only the effectiveness of each tested intervention but also provide meaningful information regarding effectiveness across key subgroups of patients. However, the parent project will not assess CS or sleep disturbance, due to the additional expertise, expense, equipment and time required. A mechanistic evaluation of these factors is required to substantiate their impact on treatment response. The current proposal seeks to substantiate whether the conceptual understanding of these factors is legitimate. The project will also evaluate whether advanced understanding of CS and sleep disturbance are important contributions on top of the more easily quantified phenotypes collected in the parent project. The knowledge gained will inform patient phenotyping to better match patients with effective interventions, ultimately reducing the substantial heterogeneity across intervention outcomes and reliance on opioid therapies.

项目摘要/摘要 膝骨性关节炎(KOA)是全世界慢性疼痛和残疾的主要原因之一，影响超过 30%的老年人，对个人和社会来说是一个重大的全球健康和经济负担。这个 在过去的70年里，膝关节骨质疏松症的发生率增加了一倍多，而且由于生活水平的提高，这种比率还在继续急剧增长 预期和人口BMI。手术通常用于治疗膝关节骨性关节炎，但与高发病率有关。 持续的疼痛并不是永久的解决办法。许多非手术疗法被提倡用来治疗 膝关节骨性关节炎患者的疼痛。越来越多的文献证明增强了中枢神经系统的疼痛处理， 被称为中枢敏化(CS)，在膝关节骨性关节炎患者中产生广泛的敏感性。沉睡 精神障碍与CS有关，但它本身给遭受疼痛的患者带来了可怕的负担。 CS和睡眠障碍都是各种慢性疼痛的特征和重要的治疗方法 考虑因素，两者独立地与疼痛的开始和维持有关，以及 加重疼痛严重程度 。为当前提案提供平台的父项目将对 对膝关节骨性关节炎的行为、药物和程序干预；一种允许多次 治疗比较和表型分型，以改善每种治疗的选择，预计将得到完善 并减少不必要的干预。这项研究的结果将遵循务实的 原则，以便最大限度地向利益攸关方提供信息，将不仅涉及有效性 ，而且还提供了关于关键的 患者的亚组。然而，母项目不会评估CS或睡眠障碍，因为 所需的额外专业知识、费用、设备和时间。对这些因素的机械评估是 以证实其对治疗反应的影响。目前的建议旨在证实 对这些因素的概念性理解是否合法。该项目还将评估是否 对CS和睡眠障碍的高级理解是更容易实现的重要贡献 量化在父项目中收集的表型。所获得的知识将使患者的表型分析 更好地将患者与有效的干预措施相匹配，最终降低 干预结果和对阿片类药物治疗的依赖。