Neurobiological and Psychological Benefits of Exercise in Chronic Pain and PTSD

运动对慢性疼痛和创伤后应激障碍（PTSD）的神经生物学和心理益处

• 批准号: 8593668
• 负责人: Erica Rose Checko
• 金额: --
• 依托单位: VA BOSTON HEALTH CARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-10-01 至 2018-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8593668
• 关键词: Accounting; Acute; Adherence; Aerobic; Afghanistan; Allopregnanolone; American; Ants; Area; Award; Biological; Blood Pressure; Body Weight decreased; Boston; Cardiology; Cardiopulmonary; Chronic; Chronic stress; Clinical; Clinical Research; Clinical Trials; Cognitive; Complex; Conflict (Psychology); Data; Development; Disease; Drops; Emotional; Exercise; Exercise Physiology; Exercise stress test; Exposure to; Fostering; Foundations; Functional disorder; Funding; Future; Generations; Goals; Grant; Guidelines; Health; Health behavior change; Healthcare; Healthcare Systems; Heart Rate; Home environment; Hormones; Individual; Injury; Intervention; Iraq; Measurable; Measures; Mediating; Mental Depression; Military Personnel; Moderate Exercise; Modification; Monitor; Morbidity - disease rate; Motivation; Neurobiology; Neurohormones; Neuromodulator; Neuropsychology; Nociception; Pain; Pain Threshold; Participant; Patient Self-Report; Patients; Physiological; Plasma; Population; Post-Traumatic Stress Disorders; Pregnanolone; Prevalence; Problem Solving; Protocols documentation; Psychophysiology; Publishing; Questionnaires; Regimen; Rehabilitation Research; Research; Research Design; Research Support; Role; Running; Scientist; Self Efficacy; Services; Severities; Sex Characteristics; Stress; Symptoms; Telephone; Testing; Time; Training; Training Programs; Training and Education; Translational Research; Trauma; Traumatic Brain Injury; United States National Institutes of Health; Veterans; Walking; War; Woman; Work; alternative treatment; base; behavior change; chronic pain; clinically significant; college; comparison group; cost; disability; experience; follow-up; health administration; improved; indexing; innovation; neuropeptide Y; prevent; programs; psychologic; psychological trauma; public health relevance; research and development; response

DESCRIPTION This study will explicitly compare the effects of a 12-week progressive exercise training program on 1) the clinical symptoms of chronic pain and PTSD, 2) pain threshold and tolerance, and 3) anti-stress, anti- nociceptive neurohormones such as neuropeptide Y (NPY) and allopregnanolone/pregnanolone (ALLO) in veterans with chronic pain/PTSD compared to healthy comparison participants. The revised study design includes a baseline cardiopulmonary exercise assessment (CPX) that will inform the exercise prescription for a 12-week "progressive exercise" training program, comprised of three 30-45 minute exercise sessions per week (walking or running, depending on the ability/capacity of the participant). Exercise sessions will be initially supervised by an exercise physiologist in the Clinical Studies Unit (CSU) at the VA Boston Healthcare System and then each participant will transition into the home. Weekly telephone calls by the PI will provide additional motivational support and assistance with problem solving. Implementation of the prescribed exercise regimen will also be supported by the use of heart rate and actigraph monitors programmed for the participant to achieve their prescribed heart rate range (HRR). Finally, an "endpoint" maximum load exercise assessment will occur at week 13 in order to track measurable change for both psychological and neurobiological factors and to delineate their impact on pain indices and PTSD symptomatology. Both maximum load exercise tests will be performed in accordance with guidelines published by the American College of Cardiology. Measures of pain, pain tolerance (via the cold pressor test) will be implemented 30 minutes before and 30 minutes after exercise testing as well as at a midpoint "check-in" at which self-report questionnaires will also be repeated. Based on the PI's earlier research, the role of exercise motivation and self-efficacy on changes in perceived pain and pain tolerance will be correlated with changes in NPY and ALLO levels, pre and post exercise. It is anticipated that differences in biological responses to aerobic and anaerobic exercise between healthy participants and those with chronic pain/PTSD will predict differences in the psychological and pain-reducing benefits of aerobic and anaerobic exercise. Once identified, such factors could be augmented by modification of the exercise regimen in order to help enhance the ant-stress hormone levels for the pain/PTSD population and experience clinically significant reductions in their symptoms. In order to obtain sufficient power as well as accounting for an expected drop-out rate of 18-20%, the proposed recruitment is 30 participants per condition (total of 60 participants). Data from this pilot work will be used to compute effect sizes in support of a future clinical trial incorporating individually prescribed exercise regimens and a motivationally based exercise behavior change intervention aimed at reducing pain and PTSD symptoms in our Veterans. Advanced education and training is sought by this CDA-2 award applicant in four broad areas: 1) psychophysiology of chronic pain and PTSD with a sub-focus on sex differences, 2) the neurobiology of chronic stress, PTSD, and pain, 3) exercise physiology and 4) the neuropsychology and neurobiology of traumatic brain injury (TBI). The combination of didactic and experiential training in these areas will serve the PI's long-term goal of becoming an independent scientist/practitioner in the VA focused on development of improved treatments for health conditions co-morbid with PTSD such as chronic pain and mild TBI. In the shorter-term, this CDA-2 will allow the PI to develop a more effective, motivationally based, exercise behavior change protocol that fosters long- term exercise compliance in patients with chronic pain/PTSD. This intervention will be used as an adjunct to cognitive interventions for these disorders to be further developed and studied via a larger VA, NIH, or DOD- funded grant for which the PI will apply in years 4-5 of the CDA2.

描述 本研究将明确比较患有慢性疼痛/PTSD 的退伍军人与健康对照者相比，为期 12 周的渐进式运动训练计划对 1) 慢性疼痛和 PTSD 的临床症状，2) 疼痛阈值和耐受性，以及 3) 抗压力、抗伤害性神经激素（如神经肽 Y (NPY) 和四氢孕酮/孕酮 (ALLO)）的影响 参与者。修订后的研究设计包括基线心肺运动评估 (CPX)，它将为为期 12 周的“渐进运动”训练计划提供运动处方，该计划包括每周 3 次 30-45 分钟的运动课程（步行或跑步，取决于参与者的能力/能力）。运动课程最初将由 VA 波士顿医疗系统临床研究部门 (CSU) 的运动生理学家监督，然后每位参与者将过渡到家中。 PI 每周的电话将为解决问题提供额外的激励支持和帮助。规定的锻炼方案的实施还将通过使用为参与者编程的心率和活动记录仪监测器来支持，以达到其规定的心率范围（HRR）。最后，“终点”最大负荷运动评估将在第 13 周进行，以跟踪心理和神经生物学因素的可测量变化，并描述它们对疼痛指数和 PTSD 症状的影响。两项最大负荷运动测试将根据美国心脏病学会发布的指南进行。疼痛、疼痛耐受性（通过冷加压测试）的测量将在运动测试前 30 分钟和运动测试后 30 分钟以及中间“登记”时进行，在此期间还将重复自我报告问卷。根据 PI 的早期研究，运动动机和自我效能对感知疼痛和疼痛耐受性变化的作用将与运动前后 NPY 和 ALLO 水平的变化相关。预计健康参与者和患有慢性疼痛/创伤后应激障碍的参与者对有氧运动和无氧运动的生物反应的差异将预测有氧运动和无氧运动的心理和减轻疼痛益处的差异。一旦确定，这些因素可以通过修改运动方案来增强，以帮助提高疼痛/创伤后应激障碍人群的抗应激激素水平，并在临床上显着减轻其症状。为了获得足够的电力以及 考虑到预计退出率为 18-20%，建议招募每个条件 30 名参与者（总共 60 名参与者）。这项试点工作的数据将用于计算效果大小，以支持未来结合单独规定的运动方案的临床试验 以及基于动机的运动行为改变干预措施，旨在减少退伍军人的疼痛和创伤后应激障碍症状。 CDA-2 奖申请人寻求四个广泛领域的高级教育和培训：1) 慢性疼痛和 PTSD 的心理生理学，重点关注性别差异；2) 慢性压力、PTSD 和疼痛的神经生物学；3) 运动生理学；4) 创伤性脑损伤 (TBI) 的神经心理学和神经生物学。这些领域的教学和体验式培训相结合将有助于 PI 的长期目标 成为 VA 的独立科学家/从业者的重点是开发针对与 PTSD 共存的健康状况（例如慢性疼痛和轻度 TBI）的改进治疗方法。从短期来看，该 CDA-2 将使 PI 能够制定更有效、基于动机的运动行为改变方案，以促进慢性疼痛/创伤后应激障碍 (PTSD) 患者的长期运动依从性。该干预措施将用作针对这些疾病的认知干预措施的辅助手段，通过 VA、NIH 或 DOD 资助的更大拨款进一步开发和研究，PI 将在 CDA2 的第 4-5 年申请该拨款。