Sleep and Pain Interventions in Fibromyalgia: Hyperalgesia and Central Sensitizat

纤维肌痛的睡眠和疼痛干预：痛觉过敏和中枢敏化

• 批准号: 7941684
• 负责人: Christina S McCrae
• 金额: $ 33.43万
• 依托单位: UNIVERSITY OF FLORIDA
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-09-29 至 2012-09-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7941684
• 关键词: Address; Affect; Aftercare; American; Anxiety; Arousal; Behavior Therapy; Behavioral; Cancer Patient; Chronic; Chronic Insomnia; Clinical; Cognitive; Control Groups; Data; Development; Disease; Effectiveness; Evaluation; Experimental Designs; Fibromyalgia; Health; Hyperalgesia; Influentials; Intervention; Israel; Laboratories; Lead; Link; Literature; Maintenance; Measures; Mediating; Mediator of activation protein; Medical; Modeling; Names; Nature; Nociception; Outcome; Outcome Measure; Pain; Participant; Patients; Pattern; Play; Posterior Horn Cells; Price; Public Health; Publishing; Randomized; Randomized Clinical Trials; Relative (related person); Reporting; Research; Research Design; Resolution; Role; Sampling; Sleep; Sleep Architecture; Sleep Stages; Sleep disturbances; Sleeplessness; Staging; Stimulus; Stress; Structure; Symptoms; Testing; Time; Vulnerable Populations; Waiting Lists; Weight; Work; central sensitization; chronic pain; cognitive behavior therapy; depression; design; disturbance in affect; experience; improved; patient population; public health relevance; sleep onset; theories

DESCRIPTION (provided by applicant): Approximately 50-70% of patients with chronic pain, particularly fibromyalgia sufferers, report sleep difficulties. Because it is not possible to randomly induce chronic pain or chronic insomnia in otherwise healthy participants, the exact nature of the sleep/pain relationship is not well understood. Fortunately, established cognitive behavioral treatments (CBT) treatments for insomnia (CBT-I) and pain (CBT-P) offer an excellent opportunity to examine the causal links between these two disorders. The purpose of this study is to examine the relationship between chronic pain and sleep disturbance in fibromyalgia patients. CBT-I and CBT-P will be used to examine the causal links between sleep and pain. Specific Aims 1 and 2 involve a randomized clinical trial (RCT) to evaluate the effects on sleep and pain of CBT-I and CBT-P against a waitlist control in fibromyalgia patients with insomnia. Sleep may play an etiological role in the chronicity of chronic pain conditions. Furthermore, the maintenance of chronic pain conditions can ultimately lead to a state of central sensitization (increased responsiveness of dorsal horn neurons, and perhaps other CNS structures to stimuli). Specific Aim 3 investigates the effect of improved sleep on central sensitization of pain, and Specific Aim 4 investigates the indirect effects of pain reduction on improvements in sleep outcomes. We propose to test specific hypotheses inherent in the Cognitive Activation Theory of stress (CAT). Sustained arousal and lack of arousal resolution (i.e., through restful sleep) has been implicated in the development of central sensitization. Also consistent with the CAT model is the hypothesis that negative affect (e.g., depression, anxiety) leads to central sensitization. Specific Aim 5 investigates multivariate models of the relationship of pain, sleep, negative affect, and central sensitization as a test of the Cognitive Activation Theory of stress in Fibromyalgia. Both of these hypotheses are consistent with preliminary data collected in our laboratory linking both chronic pain conditions, and negative affect to central sensitization of pain in fibromyalgia patients. Public Health Relevance Paragraph: Chronic insomnia in the context of chronic pain represents a major health threat for many Americans. This research addresses the public health need for information on the relationship between chronic insomnia and chronic pain and the effect of cognitive behavioral interventions that target insomnia (CBT-I) and pain (CBT-P) in this vulnerable population. The information to be gained has broad implications not only for other patient populations likely to suffer from insomnia and pain (i.e., cancer patients), but also for those suffering from other behavioral/heath concerns (i.e., weight management, depression).

描述（由申请人提供）： 大约 50-70% 的慢性疼痛患者，尤其是纤维肌痛患者，报告有睡眠困难。由于不可能在其他健康的参与者中随机诱发慢性疼痛或慢性失眠，因此睡眠/疼痛关系的确切性质尚不清楚。幸运的是，针对失眠 (CBT-I) 和疼痛 (CBT-P) 的认知行为疗法 (CBT) 治疗方法为研究这两种疾病之间的因果关系提供了绝佳的机会。本研究的目的是探讨纤维肌痛患者慢性疼痛与睡眠障碍之间的关系。 CBT-I 和 CBT-P 将用于检查睡眠和疼痛之间的因果关系。具体目标 1 和 2 涉及一项随机临床试验 (RCT)，以评估 CBT-I 和 CBT-P 与候补名单对照对失眠纤维肌痛患者的睡眠和疼痛的影响。睡眠可能在慢性疼痛的慢性过程中发挥病因作用。此外，慢性疼痛状况的持续可能最终导致中枢敏化状态（背角神经元以及其他中枢神经系统结构对刺激的反应性增加）。具体目标 3 研究改善睡眠对中枢疼痛敏感的影响，具体目标 4 研究减少疼痛对改善睡眠结果的间接影响。我们建议测试压力认知激活理论（CAT）中固有的具体假设。持续的觉醒和缺乏觉醒解决（即通过安宁的睡眠）与中枢敏化的发展有关。与 CAT 模型一致的是，负面情绪（例如抑郁、焦虑）导致中枢敏感化的假设。具体目标 5 研究疼痛、睡眠、负面情绪和中枢敏化之间关系的多变量模型，作为纤维肌痛应激认知激活理论的测试。这两种假设都与我们实验室收集的初步数据一致，这些数据将慢性疼痛状况和纤维肌痛患者疼痛中枢敏化的负面影响联系起来。 公共卫生相关段落：慢性疼痛背景下的慢性失眠对许多美国人来说是一个主要的健康威胁。这项研究满足了公众健康对慢性失眠和慢性疼痛之间关系的信息需求，以及针对这一弱势群体中失眠 (CBT-I) 和疼痛 (CBT-P) 的认知行为干预措施的效果。获得的信息不仅对可能患有失眠和疼痛的其他患者群体（即癌症患者）具有广泛的影响，而且对那些患有其他行为/健康问题（即体重管理、抑郁）的患者也具有广泛的影响。