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(包括受过补充和替代医学(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)。拟议的奖学金计划是为了培养脊椎医生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，特别是功能磁共振成像(FMRI)。这位研究员将参与佛罗里达大学几个中心和实验室的研究，这些中心和实验室检查生物、心理和社会对疼痛感知的影响。该培训计划的核心是初级导师资助的NIH R01-AT006334-01项目。这项研究测量了急性运动性下腰痛的生物学方面(如疼痛敏感性、功能磁共振成像)和心理方面(如恐惧、信念、期望)。该项目还评估了脊柱手法治疗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。本申请中提出的研究将是通过收集静息状态功能磁共振成像而进行的更大研究的一部分和补充。这一应用的中心假设是，由腰背部肌肉损伤后神经活动增加引发的皮质重组与中枢敏化相关，可以通过静息状态的fMRI进行监测。这一研究大脑功能网络机制的强大工具将被用于纵向评估相关大脑区域之间的功能连接，如初级和次级躯体感觉皮质、脑岛、前扣带回皮质、丘脑和中脑导水管周围灰质。其具体目的是：(1)测量疼痛过敏症短暂状态之前、期间和之后跨脑区同步神经元活动的变化，以及(2)测量脊柱手法对同步神经活动的即时影响。通过本课程的完成，研究员将(1)深入了解一系列评估疼痛感知的模型和方法，包括疼痛体验的生理、心理和环境成分，以及(2)为开展评估手法和基于身体的干预的潜在神经生理学机制及其临床相关性的研究计划奠定坚实的基础。这项脊椎按摩医师奖学金培训计划适合NCCAM的使命，因为它(1)专注于由脊椎按摩师经常为美国公众提供的针对下腰痛的CAM干预， 以及(2)研究疼痛缓解背后潜在的神经生理学机制，这就是为什么干预最常用的原因。

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.