Pathophysiology of Active and Latent Myofascial Trigger Points

主动和潜在肌筋膜触发点的病理生理学

• 批准号: 10352066
• 负责人: ALBERT F MORASKA
• 金额: $ 22.46万
• 依托单位: UNIVERSITY OF COLORADO DENVER
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-05-01 至 2024-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10352066
• 关键词: ASIC channel; Address; Assessment tool; Biological Markers; Blood flow; Branched-Chain Amino Acids; Carbohydrates; Carbon; Carpal Tunnel Syndrome; Cell physiology; Cellular Stress; Ceramides; Chemicals; Clinical; Contracts; Crohn' s disease; Degenerative polyarthritis; Development; Disease; Educational workshop; Environment; Exhibits; Functional disorder; Funding Opportunities; Glucose; Glycerol; Goals; Headache; Health; Helping to End Addiction Long-term; Individual; Inflammation; Intercellular Fluid; Intervention; Intervention Trial; Investigation; Ischemia; Lead; Link; Low Back Pain; Malignant Neoplasms; Massage; Measures; Medical; Metabolic; Metabolism; Microdialysis; Mind-Body Intervention; Modeling; Muscle; Myalgia; Myofascial Pain Syndromes; Myofascial Trigger Point; Neurons; Nociceptors; Nodule; Outcome; Output; Pain; Palpable; Palpation; Parkinson Disease; Pathway interactions; Patients; Physical Examination; Physiological; Physiology; Postoperative Pain; Prevention strategy; Pyrrolidonecarboxylic Acid; Pyruvate; Research; Resolution; Respiration; Running; Sampling; Site; Skeletal Muscle; Sphingolipids; Study models; Suggestion; Symptoms; System; Techniques; Tension Headache; Testing; Tissues; Treatment Effectiveness; Triglycerides; United States National Institutes of Health; Vertebral column; base; cancer pain; chronic pain; clinical pain; clinically relevant; effective therapy; energy balance; experience; experimental study; insight; interstitial; ischemic injury; lipid metabolism; metabolome; metabolomics; osteoarthritis pain; pain reduction; pain sensitivity; physical state; predictive modeling; prevent; relating to nervous system; response; screening; targeted treatment; trapezius muscle; treatment strategy; trigger point; ultrasound

PROJECT SUMMARY Pain deriving from a range of health concerns including headache, low back pain, osteoarthritis, carpal tunnel syndrome, as well as post-surgical and cancer pain have been linked to myofascial trigger points (TrPs). The TrP is a tender nodule along a taut band of muscle. Two states of the TrP are known to exist: active and latent. In the active state, the TrP is spontaneously painful and elicits pain referral mimicking the clinical complaint. The latent TrP is not spontaneously painful and any referred pain it elicits upon palpation is not related to a clinical pain complaint; the latent TrP is thought to be an intermediary state between healthy and an active TrP. Evidence from ultrasound indicates latent TrPs exhibit reduced blood flow, which is further reduced in active TrPs, suggestive of metabolic disruption and cellular stress. In line with that observation, hypothesized TrP models predict reduced glucose and elevated lactate in TrPs, however a pilot massage intervention trial that reduced active TrP pain found no change in glucose and an increase in lactate. The discrepancy between the TrP model and empirical evidence argues that cellular metabolism within a TrP may behave differently than the well-accepted model predicts. Lactate has also been linked to nociceptor sensitization, which could explain differences in local or referred pain experience. Furthermore, the differences in blood flow between latent and active TrPs could result in metabolic differences that may be informative as to the formation, progression, and perpetuation of TrPs. The present study will use a targeted and non-targeted metabolomics approach to understand the metabolic environment within both types of trigger points and healthy muscle. Latent TrPs from healthy individuals and active TrPs from individuals with tension-type headache will be investigated. The targeted approach will focus on glucose and lactate to determine whether carbohydrate energy balance is different within healthy muscle and trigger point sites. The non-targeted approach will screen for thousands of metabolic biomarkers within healthy muscle and the TrPs to identify relative differences in metabolites that could identify which metabolites lead to development of a latent TrP, progression to an active TrP, or perpetuation of the active TrP. The experiments described in this proposal will provide insight into the internal environment of TrPs. Should this exploratory study reveal disruption to carbohydrate energy balance or identify differences in biomarkers within latent or active TrPs a mechanism for the formation or progression of the TrP will become clear. This information could be used to optimize intervention techniques that will reverse or prevent muscle-derived pain. This proposed study will address the key goal to “Develop and validate biomarkers for chronic pain or other key symptoms to be used in studies of mind and body approaches” from the Funding Opportunity Announcement PA-18-322.

项目摘要 疼痛来自一系列健康问题，包括头痛，腰痛，骨关节炎，腕管 综合征以及术后和癌症疼痛与肌筋膜触发点（TRP）有关。 TRP是沿着肌肉绷紧的肌肉带。已知TRP的两个状态存在：活跃和潜在。 在主动状态下，TRP是赞助的，痛苦的，并引起模仿临床抱怨的痛苦。 潜在的TRP并不是赞助的痛苦，触诊时引起的任何转介疼痛与 临床疼痛抱怨；潜在的TRP被认为是健康和主动TRP之间的中间状态。 超声指示潜在TRP暴露的证据降低了血流，这进一步降低了活性 TRP，暗示代谢破坏和细胞应激。根据该观察，假设的TRP 模型预测TRP中的葡萄糖和裂缝升高，但是试点按摩干预试验， 减轻活性TRP疼痛发现葡萄糖没有变化和鞋底增加。差异 TRP模型和经验证据表明，TRP内的细胞代谢的行为可能与 经过良好接受的模型预测。乳酸也与伤害感受器的敏感性有关，这可以解释 本地或转介疼痛经历的差异。此外，潜在和 主动TRP可能会导致代谢差异，这些差异可能有关形成，进展和 TRP的永久性。 本研究将采用针对性和非靶向代谢组学方法来了解代谢 两种类型的触发点和健康肌肉的环境。来自健康个体的潜在TRP 将研究来自具有张力型标题的个体的主动TRP。目标方法将集中 在葡萄糖和裂缝上，以确定健康肌肉中的碳水化合物能量平衡是否不同 和触发点站点。非目标方法将筛选成千上万的代谢生物标志物 健康的肌肉和TRP，以鉴定代谢产物的相对差异，这些代谢物可以识别哪些代谢产物 导致潜在TRP的发展，进展为活动性TRP或活性TRP的永久性。 本提案中描述的实验将为TRP的内部环境提供见解。应该 这项探索性研究揭示了碳水化合物能量平衡或确定生物标志物的差异的中断 在潜在或活跃的TRP中，TRP形成或进展的机制将变得清晰。这 信息可用于优化干预技术，这些技术将逆转或防止肌肉衍生的疼痛。 这项拟议的研究将针对“开发和验证生物标志物的慢性疼痛或其他 从资金机会中研究的关键症状” 公告PA-18-322。