Impact of exercise training on pain and brain function in Gulf War Veterans

运动训练对海湾战争退伍军人疼痛和大脑功能的影响

• 批准号: 8698364
• 负责人: DANE B. COOK
• 金额: --
• 依托单位: WM S. MIDDLETON MEMORIAL VETERANS HOSP
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-07-01 至 2016-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8698364
• 关键词: Acute; Address; Adoption; Aerobic; Aerobic Exercise; Affect; Anisotropy; Anxiety; Area; Arthralgia; Attention; Attenuated; Award; Behavior; Behavioral; Biological Markers; Brain; Brain region; Chronic; Clinical; Clinical Trials Design; Cognitive; Controlled Clinical Trials; Country; Data; Diffusion Magnetic Resonance Imaging; Disease; Epidemiologic Studies; Exercise; Exhibits; Fatigue; Fibromyalgia; Financial compensation; Freedom; Functional Magnetic Resonance Imaging; Funding; Goals; Gulf War; Health; Hour; Image Analysis; Insula of Reil; Intervention; Laboratories; Link; Maintenance; Measurement; Measures; Medical; Mental Depression; Mental Health; Methods; Military Personnel; Musculoskeletal Pain; Myalgia; Neuraxis; Nociception; Outcome; Pain; Pain Research; Painless; Participant; Pathway interactions; Patient Self-Report; Patients; Pattern; Performance; Persian Gulf; Personal Satisfaction; Physical Function; Physical activity; Population; Process; Property; Protocols documentation; Psychophysics; Quality of life; Randomized; Randomized Controlled Trials; Recruitment Activity; Regulation; Reporting; Research; Resistance; Rest; SF-36; Sensory Process; Services; Sleep; Soldier; Stimulus; Structure; Symptoms; Techniques; Testing; Thalamic structure; Time; Training; Training Programs; Treatment Effectiveness; United States; Veterans; Visual; Waiting Lists; War; Woman; Work; analog; base; behavior test; blood oxygen level dependent; care seeking; chronic pain; cingulate cortex; clinically significant; cooking; coping; design; disability; discount; effective therapy; experience; follow-up; heat stimulus; hemodynamics; imaging modality; impression; improved; men; midbrain central gray substance; neuroimaging; novel; novel strategies; operation; pain inhibition; physical conditioning; premature; primary outcome; relating to nervous system; response; secondary outcome; self esteem; sensory cortex; sensory stimulus; social; treatment response; treatment trial; trial comparing; white matter

Summary The overall aim is to determine the efficacy of resistance exercise training (RET) for the treatment of Gulf War Veterans (GVs) suffering from chronic musculoskeletal pain (CMP). In addition, we will assess the influence of RET on total physical activity levels, pain sensitivity and pain regulation, and brain white matter tracts. By applying functional neuroimaging techniques in conjunction with pain psychophysics, we will be able to determine how the brains of Veterans with CMP respond to pain and whether these responses can be modified by RET. We plan to use blood oxygen level dependent (BOLD) and diffusion tensor imaging (DTI) methods in conjunction to evaluate brain regions involved in pain processing and control and the microstructural properties of white matter tract pathways that connect these regions. In addition, we will determine the influence of RET on physical activity behaviors. The primary goals of this project will be accomplished by comparing GVs with CMP assigned to RET with those assigned to wait-list control (WLC) in a randomized controlled trial. The specific aims of the project are to determine the influence of RET on: 1) pain symptoms, physical function, and patient global impression of change (PGIC); 2) total daily physical activity levels; 3) brain mechanisms of pain sensitivity and regulation; and 4) pain-relevant brain white matter tracts involved in pain processing and control. Sixty-four Veterans will be randomly assigned to either 16 weeks of either RET or WLC. Follow-up assessments of primary and secondary outcomes will occur at 6 and 12 months post RET and WLC. RET will consist of exercises that target the entire body and gradually progress from low to moderate intensity loads over time. Total work will be measured during exercise to demonstrate a training effect. Physical activity levels in both groups will be assessed via self-report and accelerometry methods. Physical activity will be assessed at baseline; at weeks 5, 10, and 16 of RET and WLC; and at 6- and 12-month follow-ups. Pain sensitivity and pain regulation will be assessed using pain psychophysical and functional magnetic resonance imaging methods. Pain sensitivity and pain regulation will be assessed at baseline; at weeks 6, 11, and 17 of RET and WLC; and at 6- and 12-month follow-ups. Brain white matter tract structure will be determined using DTI methods and will be assessed at baseline; at weeks 6, 11, and 17 of RET and WLC; and at 6- and 12-month follow-ups. We expect that by the end of the trial, GVs with CMP assigned to RET will show: 1) statistically significant and clinically meaningful improvements in self-reported pain, physical function & PGIC and secondary outcomes (sleep, self-esteem, fatigue, anxiety and depression); 2) increases in total physical activity that are attributable to an increase in RET; 3) decreased pain ratings and decreased brain responses to experimental pain stimuli; 4) decreased brain responses in areas that process the sensory aspects of pain and increased brain responses in areas that modulate or inhibit pain processing during a distracting cognitive task; and 5) improvements in DTI measures of brain white matter tract structures. The goals of this project are consistent with the Department of Veterans Affairs' call for "Research on New Treatments for Gulf War Veterans' Illness" by proposing a controlled clinical trial 1) in a clearly defined Gulf War Veteran population with a specific symptom (CMP), 2) with appropriately defined and clinically meaningful endpoints, and 3) that identifies potential biomarkers that are explanatory or predictive of a treatment response. No efficacious treatments have been identified for GVs with CMP; however, resistance exercise training remains an inadequately explored yet promising treatment based on successful trials with civilians suffering from chronic pain. We have designed a resistance exercise treatment trial that has the potential to benefit Veterans' health and to begin to determine potential mechanisms of pain maintenance in CMP.

摘要 总体目标是确定抵抗运动训练(RET)在海湾战争治疗中的有效性 患有慢性肌肉骨骼疼痛的退伍军人(GV)。此外，我们还将评估 RET的总体力活动水平，疼痛敏感性和疼痛调节，以及脑白质束。通过 将功能神经成像技术与疼痛心理物理学相结合，我们将能够 确定患有慢性萎缩性脑病的退伍军人的大脑如何对疼痛做出反应，以及这些反应是否可以改变 由RET提供。我们计划使用血氧水平依赖(BOLD)和扩散张量成像(DTI)方法在 联合评估参与疼痛处理和控制的脑区和微结构特性 连接这些区域的白质束路径。此外，我们将确定RET的影响 对身体活动行为的影响。该项目的主要目标将通过比较GV和 在一项随机对照试验中，分配给RET的CMP和分配给等待名单对照(WLC)的患者。这个 该项目的具体目标是确定RET对以下方面的影响：1)疼痛症状、身体功能和 患者总体变化印象(PGIC)；2)每日总体力活动水平；3)疼痛的大脑机制 敏感性和调节；4)与疼痛相关的脑白质束参与疼痛的处理和调节 控制力。64名退伍军人将被随机分配到RET或WLC的16周。跟进 对初级和次级结果的评估将在RET和WLC后6个月和12个月进行。RET将会 包括以全身为目标的运动，并从低强度负荷逐渐发展到中等强度负荷 随着时间的推移。总工作量将在锻炼过程中进行测量，以展示训练效果。体力活动水平 两组都将通过自我报告和加速度法进行评估。将对体力活动进行评估 在基线；在RET和WLC的第5、10和16周；在6个月和12个月的随访中。疼痛敏感和 疼痛调节将使用疼痛心理物理和功能磁共振成像进行评估 方法：研究方法。疼痛敏感性和疼痛调节将在基线时进行评估；在RET的6、11和17周以及 WLC；以及6个月和12个月的随访。脑白质束结构将使用DTI来确定 将在基线、RET和WLC的6、11和17周以及6个月和12个月时进行评估 后续行动。我们预计，在试验结束时，被分配到RET的GV将显示：1)统计 在自我报告的疼痛、身体功能和PGIC和 次要结果(睡眠、自尊、疲劳、焦虑和抑郁)；2)总体体力增加 可归因于RET增加的活动；3)降低疼痛等级和大脑反应 对实验性疼痛刺激的反应；4)处理疼痛感觉方面的区域的大脑反应减弱 在分散注意力的认知过程中，调节或抑制疼痛处理的区域的大脑反应增加 任务；以及5)改进脑白质束结构的DTI测量。这个项目的目标是 符合美国退伍军人事务部的号召，即“研究海湾战争的新疗法” 通过提议在明确界定的海湾战争退伍军人群体中进行对照临床试验 特定症状(CMP)，2)具有适当定义并具有临床意义的终点，以及3) 确定可解释或预测治疗反应的潜在生物标志物。无效药 已经确定了患有慢性萎缩性胃炎的GV的治疗方法；然而，阻力运动训练仍然是一种 基于对患有慢性病的平民的成功试验，未充分探索但有希望的治疗方法 疼痛。我们设计了一项阻力运动治疗试验，有可能有益于退伍军人的健康 并开始确定CMP中维持疼痛的潜在机制。