Sleep Disturbance and Pain Sensitivity in Chronic Pain

描述（由申请人提供）：该职业发展奖（K23）将为候选人提供必要的培训，以建立一个研究计划，以评估慢性疼痛障碍中睡眠障碍的原因，后果和治疗。慢性疼痛是一个主要的健康问题，导致严重的痛苦和经济负担。睡眠障碍是慢性疼痛障碍的一个突出和致残性特征。虽然流行病学研究发现，睡眠障碍大大增加了严重的医疗和精神疾病的风险，慢性疼痛的睡眠研究是相当有限的，质量差。对健康受试者的实验研究表明，疼痛和睡眠之间的关系可能是相互的，例如疼痛干扰睡眠，睡眠中断增强疼痛敏感性。这种关系在临床人群中研究不足，缺乏经验性治疗方法。候选人的教育计划包括指导，教学和经验，旨在实现3个职业发展目标：1）获得疼痛评估的专业知识，2）获得多导睡眠图的专业知识，3）发展临床试验方法的基础。计划提供定量感觉测试、定量EEG和临床试验方面的专家指导。教学包括神经科学，生物统计学和临床试验的进行课程。 该研究计划提出了一项前瞻性研究睡眠与颞下颌关节紊乱病（TMD）相关的慢性肌筋膜疼痛患者。这项研究将：1）使用自我报告、活动监测和多导睡眠图来表征TMD中睡眠障碍的性质，2）评估失眠和/或睡眠微结构异常的诊断是否与压力疼痛阈值降低相关，以及3）确定睡眠测量是否预测短期（2个月）疼痛严重程度。根据纵向研究的结果和候选人在临床试验方法方面的培训，最后一年的奖励将包括进行试点临床试验（N=10），以确定认知行为干预的可行性，并测试合适的安慰剂干预治疗慢性疼痛睡眠障碍的可信度。候选人的K23研究和培训计划将为睡眠障碍的独立调查提供基础，作为发展慢性疼痛的可改变风险因素和治疗慢性疼痛中睡眠障碍的干预措施。

DESCRIPTION (provided by applicant): This Career Development Award (K23) will provide the candidate the necessary training to establish a program of research to evaluate the causes, consequences, and treatments of sleep disturbance in chronic pain disorders. Chronic pain is a major health problem leading to substantial suffering and economic burden. Sleep disturbance is a prominent and disabling feature of chronic pain disorders. While epidemiologic research has found that sleep disturbance substantially increases the risk of serious medical and psychiatric morbidities, sleep research in chronic pain is quite limited and of poor quality. Experimental research in healthy subjects suggests that the relationship between pain and sleep may be reciprocal, such that pain disturbs sleep and sleep disruption enhances pain sensitivity. This relationship has been inadequately studied in clinical populations and empirical approaches to treatment are lacking. The candidate's educational plan includes mentorship, didactics, and experiences designed to achieve 3 career development objectives: 1) Gain expertise in pain assessment, 2) gain expertise in polysomnography and 3) develop a foundation in clinical trials methods. Expert mentorship on quantitative sensory testing, quantitative EEG, and clinical trials is planned. Didactics include courses in neuroscience, biostatistics, and the conduct of clinical trials. The research plan proposes a prospective study of sleep in patients with chronic myofascial pain associated with temporo-mandibular joint disorder (TMD). This study will: 1) Characterize the nature of sleep disturbance in TMD using self-report, activity monitoring, and polysomnography, 2) evaluate whether the diagnosis of insomnia and/or sleep microstructure abnormalities are associated with decreased pressure pain threshold, and 3) determine whether measures of sleep predict the short-term (2-month) course of pain severity. Based on the results of the longitudinal study and the candidate's training in clinical trial methods, the final award year will include conducting a pilot clinical trial (N=10) to establish the feasibility of a cognitive-behavioral intervention and test the credibility of a suitable placebo intervention for treating sleep disturbance in chronic pain. The candidate's K23 research and training plan will provide a foundation for independent investigation of sleep disturbance as a modifiable risk factor for developing chronic pain and interventions to treat sleep disturbance in chronic pain.