Central mechanisms of chronic trigeminal pain

慢性三叉神经痛的中枢机制

• 批准号: 7320756
• 负责人: GEOFFREY EUGENE GERSTNER
• 金额: $ 19万
• 依托单位: UNIVERSITY OF MICHIGAN AT ANN ARBOR
• 依托单位国家: 美国
• 财政年份: 2007
• 资助国家: 美国
• 起止时间: 2007-08-01 至 2009-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7320756
• 关键词: Adult; Affect; American; Anxiety; Attention; Biological; Brain; Brain imaging; Brain scan; Caliber; Chronic; Classification; Compatible; Computers; Condition; Dental; Dental Impression Materials; Diagnosis; Disease; Distress; Endocrine; Environment; Etiology; Evaluation; Face; Facial Pain; Fibromyalgia; Figs - dietary; Functional Magnetic Resonance Imaging; Functional disorder; Future; Goals; Gonadal Steroid Hormones; Head; Human; Image; Invasive; Investigation; Left; Link; Localized; Low Back Pain; Lower Extremity; Magnetic Resonance Imaging; Maintenance; Masticatory muscles; Measures; Mediating; Medical; Metals; Methodology; Methods; Molds; Morphologic artifacts; Muscle; Myalgia; Nervous System Physiology; Neuraxis; Other Genetics; Outcome; Pain; Pain-Free; Palpation; Pathway interactions; Patients; Pattern; Peripheral; Population; Procedures; Psychological Factors; Psychophysiology; Relative (related person); Research Personnel; Resistance; Risk; Role; Rubber; Scanning; Selection for Treatments; Sensory; Site; Stimulus; Syndrome; Syringes; System; Tactile; Temporomandibular Joint Disorders; Testing; Treatment Efficacy; Trigeminal Neuralgia; Trigeminal System; Upper Extremity; Variant; Vulvodynia; Work; base; central pain; central sensitization; chronic pain; cohort; insight; knowledge base; novel; pressure; prototype; relating to nervous system; research study; response; trigger point

DESCRIPTION (provided by applicant): Temporomandibular disorders (TMD) affect ~ 7- 17% of the American adult population. The mechanisms that initiate and maintain TMD are not well understood; however, recent work suggests links to endocrine, autonomic and central nervous system function. This proposal will use recent advances in pain testing procedures in conjunction with functional magnetic resonance imaging (fMRI) to evaluate pathophysiological changes in the central nervous systems of human TMD patients and the association of these changes with muscle pain. Aim 1 will use unique pain testing procedures, which offer a proven measure of control over distress, anxiety and other psychological factors, to evaluate why sensitivity in the faces of TMD sufferers is regional, i.e., how and why are some sites in muscles hypersensitive whereas other muscle sites are relatively 'normal' in pain response profiles. Aim 2 involves developing a trigeminal pain testing methodology for use within the fMRI environment. Neural activity throughout central pain pathways in general and within the central trigeminal columns in particular will be studied in association with evoked pain to test the hypothesis that central circuitry is sensitized in symptomatically-specific ways. Particular attention will be paid to differences between relatively pain-free sites, relatively painful sites, and trigger point sites with pain referral patterns. The proposed studies will provide the first systematic neural imaging of trigeminal pathways in TMD sufferers. These studies could fundamentally change how such patients are evaluated and treated. The results will contribute to the knowledge base necessary for mechanistically-driven, non-invasive pain testing procedures for diagnosis, selection of treatments, and evaluation of treatment efficacy. These methods will also be useful in basic investigations of the biological basis of TMD, e.g., future work can use the evoked pain testing and neural imaging methods to study endocrine, sex hormone, genetic and other biological mechanisms that likely contribute to the etiology and pathophysiology of TMD.

描述（由申请人提供）：颞下颌疾病 (TMD) 影响约 7-17% 的美国成年人口。引发和维持 TMD 的机制尚不清楚；然而，最近的研究表明与内分泌、自主神经和中枢神经系统功能有关。该提案将利用疼痛测试程序的最新进展与功能磁共振成像 (fMRI) 相结合来评估人类 TMD 患者中枢神经系统的病理生理变化以及这些变化与肌肉疼痛的关联。目标 1 将使用独特的疼痛测试程序，该程序提供了一种经过验证的控制痛苦、焦虑和其他心理因素的方法，以评估为什么 TMD 患者面部的敏感性是区域性的，即肌肉中的某些部位如何以及为何过敏，而其他肌肉部位的疼痛反应曲线相对“正常”。目标 2 涉及开发一种在功能磁共振成像环境中使用的三叉神经疼痛测试方法。将研究整个中枢疼痛通路的神经活动，特别是中央三叉神经柱内的神经活动与诱发疼痛的相关性，以检验中枢回路以症状特异性方式敏感的假设。将特别注意相对无痛部位、相对疼痛部位和具有疼痛转诊模式的触发点部位之间的差异。拟议的研究将提供 TMD 患者三叉神经通路的首次系统神经成像。这些研究可能从根本上改变此类患者的评估和治疗方式。研究结果将有助于建立机械驱动的非侵入性疼痛测试程序所需的知识库，以进行诊断、治疗选择和治疗效果评估。这些方法也将有助于TMD生物学基础的基础研究，例如，未来的工作可以使用诱发疼痛测试和神经成像方法来研究可能有助于TMD病因学和病理生理学的内分泌、性激素、遗传和其他生物学机制。