Mechanisms of Neural Mobilization for Chronic Pain

描述（由申请人提供）：慢性疼痛是一种普遍存在的社会致残问题。美国国家神经疾病和中风研究所（NINDS，1997年）简洁地总结了慢性疼痛对公众健康的影响，并发表了以下声明：“慢性疼痛是美国最昂贵的健康问题。腕管综合征（CTS）是一种常见的上肢慢性疼痛，导致残疾的例子。CTS的保守治疗包括药物治疗、夹板固定和运动，通常用于轻度至中度CTS患者。鉴于CTS的保守治疗已经证明了不满意的结果和有限的疗效，替代和补充方法的调查似乎是必要的。正中神经的神经松动术是一种以身体为基础的手法，已被用于治疗CTS。临床研究表明，当治疗CTS患者时，正中神经NMT与良好的结局相关。解剖学研究表明，正中神经是特别强调与NMT和运动功能的改善也已报告时，使用正中神经NMT。这些研究为NMT提供了初步支持，但尚未进行关于NMT疗效的严格临床研究，NMT机制尚未阐明。这项拨款提案的目的是调查操纵和基于身体的方法对神经系统的影响。具体而言，我们将研究正中神经NMT对慢性疼痛的发展和维持（即疼痛的中枢致敏）所涉及的神经生理机制的影响。我们的第一个具体目标是确定与健康对照组相比，CTS患者是否表现出过度的疼痛中枢敏感性。我们的第二个具体目标是确定正中神经NMT对神经系统的影响是否是减少疼痛的中枢敏感性。本研究将使用新的疼痛敏感性的措施，调查一个方面的潜在神经生理学的操纵和身体为基础的方法。这些数据也可能为将来的临床试验提供支持，研究正中神经NMT对CTS患者的疗效。

DESCRIPTION (provided by applicant): Chronic pain is a prevalent and disabling problem for society. The National Institute of Neurological Disorders and Stroke (NINDS, 1997) has succinctly summarized chronic pain's impact on public health with the following statement, "Chronic pain is the most costly health problem in America." Carpal tunnel syndrome (CTS) is a commonly occurring example of upper extremity chronic pain that causes disability. Conservative treatment of CTS involves medication, splinting, and exercise and is frequently prescribed for patients with mild to moderate CTS. Given that conservative treatment of CTS has demonstrated unsatisfactory outcomes and limited efficacy, investigation of alternative and complementary approaches seems warranted. Neural mobilization technique (NMT) for the median nerve is a manipulative and body- based method that has been used to treat CTS. Clinical studies have indicated favorable outcomes are associated with median nerve NMT when treating patients with CTS. Anatomical studies have demonstrated the median nerve is specifically stressed with NMT and improvements in motor function have also been reported when using median nerve NMT. These studies provide initial support for NMT, but rigorous clinical studies regarding NMT efficacy have not been performed and NMT mechanisms have not been elucidated. The purpose of this grant proposal is to investigate the impact a manipulative and body-based method has on the nervous system. Specifically, we will investigate median nerve NMT for its effect on a neurophysiological mechanism involved in the development and maintenance of chronic pain (ie, central sensitization of pain). Our first specific aim is to determine if patients with CTS demonstrate excessive central sensitization of pain, when compared to healthy control subjects. Our second specific aim is to determine if the median nerve NMT's effect on the nervous system is a reduction in central sensitization of pain. This study will use novel measures of pain sensitivity to investigate one aspect of the underlying neurophysiology of manipulative and body-based methods. These data may also provide support for a future clinical trial investigating the efficacy of median nerve NMT for patients with CTS.