Co-design of a gamified, attention-based intervention for chronic pain and chronic dizziness

慢性疼痛影响了近2800万英国成年人（NICE，2021），并导致其中近800万人中度至重度残疾（Fayaz et al，2016），是一个有充分记录和研究的公共卫生问题。慢性头晕的文献记载或研究较少，但英国一项基于人群的研究发现，在全科医生处注册的所有患者中，有4%经历过慢性头晕，大多数患者因其症状而丧失能力（拿撒勒等人，1999）。表面上，慢性疼痛和慢性头晕似乎是完全不同的疾病。然而，在这两种情况下，慢性症状都不能很好地用身体组织的损伤或损害来解释。相反，新的研究表明，这两种情况背后都有一种基于大脑的核心机制：体感过度警觉。体感过度警觉的特征是倾向于高度关注某些身体感觉，并且无法从这些感觉中解脱出来。这可能会改变这些感觉信号的处理方式，这意味着无害的感觉输入会被大脑误解为威胁的存在（例如，疼痛、头晕）（埃克莱斯顿，2015）。三十年来对慢性疼痛的研究，包括初级主管的研究，已经表明，对疼痛和亚疼痛感觉的体感过度警惕可以维持和加剧慢性疼痛。这已经在行为和大脑层面上被观察到。为了支持理论模型（Popkirov等人，2018），由二级主管进行的新研究同样表明，体感过度警觉（但对与平衡而不是疼痛相关的感觉）也可能是慢性头晕的基础。发现这两种疾病的基础机制相似，这带来了一个令人兴奋的机会：从对慢性疼痛的已有研究中汲取经验，可以迅速提高我们对慢性头晕的理解。同样，新兴的慢性头晕研究可能会为慢性疼痛带来未被发现的见解。拟议的项目将利用这一机会，将患有慢性疼痛的成年人和患有慢性头晕的成年人聚集在一起，共同设计一种体感过度警觉干预，旨在改善这两种疾病的症状和生活质量。该项目将开始与学生采访慢性疼痛患者和慢性头晕患者，以及治疗这些疾病的临床医生（医生，心理学家，物理治疗师），以获取有关干预参数的初始反馈，这些参数对于这两种疾病都是相关的和可接受的。这些研究结果将用于指导共同设计的体感过度警觉干预，该干预将在患有慢性疼痛（样本1）或慢性头晕（样本2）的两个成人样本中进行试点，并使用混合方法进行评估。该项目与一家健康技术初创公司合作，该公司开发了一种游戏化的、基于家庭的体感过度警觉干预原型，该原型在慢性疼痛成人的试点研究中显示出了希望。

Chronic pain, affecting almost 28 million UK adults (NICE,2021) and causing moderate-to-severe disability for almost 8 million of these (Fayaz et al, 2016), is a well-documented and well-studied public health concern. Chronic dizziness is less documented or studied, yet a UK population-based study found that 4% of all patients registered with a general practitioner experience chronic dizziness, and most are incapacitated by their symptoms (Nazareth et al, 1999).On the surface chronic pain and chronic dizziness may appear to be entirely distinct conditions. Yet, in both conditions the chronic symptoms are not well explained by injuries or damage to bodily tissue. Instead, new research indicates that a core brain-based mechanism underlies both conditions: somatosensory hypervigilance.Somatosensory hypervigilance is characterized by the tendency to pay heightened attention towards certain bodily sensations and being unable to disengage from those sensations. This can alter the way that these sensory signals are processed, meaning that innocuous sensory input is misinterpreted by the brain to indicate the presence of a threat (e.g., pain, dizziness) (Eccleston, 2015). Three decades of research on chronic pain, including by the Primary Supervisor, has shown that somatosensory hypervigilance towards painful and sub-painful sensation scan maintain and exacerbate chronic pain. This has been observed behaviorally and at the level of the brain. In support of theoretical models (Popkirov et al., 2018), new research conducted by the Secondary Supervisor similarly suggests that somatosensory hypervigilance (but towards sensations associated with balance rather than pain) may also underpin chronic dizziness. Finding that a similar mechanism underpins both conditions brings an exciting opportunity: drawing from established research on chronic pain could rapidly advance our understanding of chronic dizziness. Likewise, emerging research on chronic dizziness could bring undiscovered insights into chronic pain.The proposed project will leverage this opportunity by bringing together adults with chronic pain and adults with chronic dizziness to co-design a somatosensory hypervigilance intervention, with the aim of improving symptoms and quality of life across both conditions. The project will begin with the student interviewing patients with chronic pain and patients with chronic dizziness, and clinicians treating these conditions (physicians, psychologists, physiotherapists) to capture initial feedback on which intervention parameters are relevant and acceptable for both conditions. These findings will be used to inform a co-designed somatosensory hypervigilance intervention that will be piloted in two samples of adults with chronic pain (sample 1) or chronic dizziness (sample 2)and evaluated using a mixed-method approach. This project is in partnership with a health technology start-up company that has developed a prototype of the gamified, home-based somatosensory hypervigilance intervention that has shown promise in pilot studies of adults with chronic pain.