CENTRAL MECHANISMS OF MANIPULATIVE AND BODY-BASED INTERVENTIONS: TRAINING PROGRAM

描述（由申请人提供）：国家补充和替代医学中心（NCCAM）认识到培训临床医生，包括接受补充和替代医学（CAM）培训的临床医生成为研究人员的重要性，并鼓励他们申请F32国家研究服务奖（NRSA）。提议的奖学金项目是为脊椎指压医生提供熟练使用最先进的技术来检查疼痛处理的生理方面，如定量感觉测试（QST）和神经成像，特别侧重于功能磁共振成像（fMRI）。该研究员将参与佛罗里达大学多个中心和实验室的研究，研究生物、心理和社会对疼痛感知的影响。该培训计划的核心是主要导师的NIH资助的R01-AT006334-01项目。这项研究测量了急性运动引起的腰痛的生物学（如疼痛敏感性、功能磁共振成像）和心理（如恐惧、信念、期望）方面。该项目还评估了脊柱推拿疗法对这些生物和心理终点的影响，以及它们与疼痛、残疾和身体损伤的临床测量的关系。本应用程序中提出的研究将是通过收集静息状态fMRI进行的更大研究的一部分和补充。该应用的中心假设是，通过静息状态fMRI可以监测到下背部肌肉损伤后神经活动增加所引发的皮层重组，并与中枢致敏相关。这一研究大脑功能网络机制的有力工具将用于纵向评估大脑相关区域之间的功能连通性，如初级和次级体感皮层、脑岛、前扣带皮层、丘脑和导水管周围灰质。具体目的是：(1)测量瞬时疼痛超敏状态之前、期间和之后大脑区域同步神经元活动的变化；(2)测量脊柱操作对同步神经活动的即时影响。通过完成本课程，学员将(1)深入了解疼痛感知的一系列模型和方法，包括疼痛体验的生理、心理和环境因素；(2)为开展研究项目奠定坚实的基础，评估操纵性和基于身体的干预措施的潜在神经生理机制及其临床相关性。这个针对脊椎指压医师的奖学金培训项目适合NCCAM的使命，因为它(1)侧重于美国公众经常由脊椎指压师提供的针对腰痛的CAM干预；

DESCRIPTION (provided by applicant): The National Center for Complementary and Alternative Medicine (NCCAM) recognizes the critical importance of training clinicians, including clinicians trained in complementary and alternative medicine (CAM), to become researchers, and encourages them to apply for this F32 National Research Service Award (NRSA). The proposed fellowship program is for a chiropractic physician to develop proficiency using state-of-the-art techniques for examining physiological aspects of pain processing such as quantitative sensory testing (QST) and neuroimaging, with a particular focus on functional magnetic resonance imaging (fMRI). The fellow will participate in research across several centers and laboratories at the University of Florida that examine biological, psychological, and societal influences on pain perception. Central to this training program is the primary mentor's NIH Funded R01-AT006334-01 project. This study measures biological (e.g. pain sensitivity, fMRI) and psychological (e.g. fear, beliefs, expectation) aspects of acute exercise-induced low back pain. The project also assesses the impact of spinal manipulative therapy on those biological and psychological endpoints and their relation to clinical measures of pain, disability and physical impairment. The research proposed in this application will be a part of and complement the larger study by collecting resting-state fMRI. The central hypothesis of this application is tht the cortical reorganization, initiated by increased neural activity following a muscular injury to the low back and associated with central sensitization, can be monitored by resting-state fMRI. This powerful tool for studying network mechanisms of brain functioning will be used to longitudinally assess functional connectivity between relevant brain regions, such as the primary and secondary somatosensory cortices, insula, anterior cingulated cortex, thalamus and periaqueductal grey. The Specific Aims are to: (1) Measure changes in synchronized neuronal activity across brain regions before, during and after a transient state of pain hypersensitivity, and (2) Measure the immediate effect of spinal manipulation on the synchronized neural activity. Through completion of this program, the fellow will have (1) gained an in- depth appreciation for a range of models and methods to assess pain perception involving physiological, psychological and environmental components of the pain experience, and (2) built a solid foundation to pursue a program of research evaluating underlying neurophysiological mechanisms of manipulative and body-based interventions and their clinical relevance. This fellowship training program for a chiropractic physician is appropriate for NCCAM's mission because it (1) focuses on a CAM intervention that is frequently provided to the American public by chiropractors for low back pain, and (2) investigates a potential neurophysiologic mechanism underlying pain relief, which is why the intervention is most frequently employed.