Age-Related Differences in Psychophysical and Neurobiological Response to Pain

对疼痛的心理物理和神经生物学反应与年龄相关的差异

• 批准号: 8702449
• 负责人: RONALD L COWAN
• 金额: $ 23.55万
• 依托单位: VANDERBILT UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-07-01 至 2016-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8702449
• 关键词: Acute Pain; Adult; Affect; Affective; Age; Aging; Biological; Blood flow; Brain; Cerebrovascular Circulation; Clinical; Consensus; Cutaneous; Data; Detection; Diagnosis; Elderly; Female; Foundations; Functional Magnetic Resonance Imaging; Future; Goals; Health Care Costs; Individual; Injury; Lateral; Lead; Literature; Magnetic Resonance Imaging; Measures; Medial; Mediating; Medical; Methods; Nervous system structure; Neurobiology; Pain; Pain Measurement; Pain Threshold; Pain management; Pathway interactions; Pattern; Prevalence; Prevention; Process; Psychophysics; Public Health; Quality of life; Reporting; Rest; Risk; Sampling; Sensory; Sensory Thresholds; Sex Characteristics; Sleep disturbances; Spin Labels; Stimulus; Symptoms; System; Woman; age effect; age related; blood oxygen level dependent; chronic pain; enhancing factor; experience; improved; insight; male; men; neural model; neurophysiology; older men; older women; pain inhibition; public health relevance; relating to nervous system; response; sensory stimulus; sex; treatment strategy; young adult

DESCRIPTION (provided by applicant): Poorly treated pain in older adults is a critical public health problem. When compared to young adults, evidence suggests that older adults have more painful diagnoses, have increased sensory thresholds for pain, and are at risk for under treatment of their pain. Sex associated differences in the experience of pain are reported in the literature with women generally experiencing more pain and reporting increased sensitivity. Poorly treated pain leads to many associated symptoms, negatively impacts quality of life, and increases health care costs. Exploring the biological reasons for alterations in pain processing is essential to increasing our understanding about pain in older adults. The paucity of neurobiological evidence to support best practice pain management in older adults places these individuals at risk for poor pain management practices. The goals of this project are to determine sex and age associated psychophysical and neurophysiological differences in the processing of pain. Our pilot data in a sample of 12 male and 12 female (age-matched) healthy older adults (ages 65-81) suggests that in response to thermal pain, increasing age is associated with increased brain activation and reduced unpleasantness only in females. Using psychophysics (to measure sensory threshold and affective unpleasantness) and fMRI blood oxygenation level dependent (BOLD) methods (to measure stimulus-evoked brain activation), we will examine age-associated differences in thermal pain processing and their underlying neurophysiology in a broad range of healthy adults (age 30-89). We will also acquire resting state functional connectivity data for secondary analyses exploring whether resting state connectivity predicts psychophysical and neurophysiological responses to thermal pain. To control for the effects of altered blood flow associated with aging, we will acquire resting state arterial spin labeling MRI (ASL) data to quantify resting cerebral blood flow (CBF). We will interpret findings in the context of a proposed neural model of pain, aging, and sex. Our overall hypothesis is that age-associated nervous system changes lead to alterations in inhibitory circuits that modulate pain associated unpleasantness which place older adults, especially females, at reduced risk for detection of pain upon injury, increased risk for under treatment of pain, and increased risk for chronic pain. Altered sensory and affective processing has implications for age-related and sex-specific pain assessment and management strategies. Recent advancements in assessing experimental pain using fMRI provide a critical foundation for our long-term goals which are to determine how aging affects the psychophysics and neurobiology of pain processing and to use this information as normal baseline data for future R01 studies including older adults with painful conditions to inform improved prevention, assessment, and treatment strategies.

描述（由申请人提供）：老年人疼痛治疗不佳是一个严重的公共卫生问题。与年轻人相比，有证据表明老年人的诊断更加痛苦，疼痛的感觉阈值更高，并且存在疼痛治疗不足的风险。文献中报告了疼痛体验的性别相关差异，女性通常经历更多疼痛，并报告敏感性增加。治疗不当的疼痛会导致许多相关症状，对生活质量产生负面影响，并增加医疗保健费用。探索疼痛处理改变的生物学原因是 这对提高我们对老年人疼痛的理解至关重要。缺乏神经生物学证据来支持老年人疼痛管理的最佳实践，使这些人处于疼痛管理实践不佳的风险之中。这个项目的目标是确定性别和年龄相关的心理生理和神经生理差异的疼痛处理。我们在12名男性和12名女性（年龄匹配）健康老年人（年龄65-81岁）的样本中的试验数据表明，在对热痛的反应中，年龄的增加与大脑激活的增加和只有女性的不愉快减少有关。使用心理物理学（测量感觉阈值和情感不愉快）和fMRI血氧水平依赖（BOLD）方法（测量刺激诱发的大脑激活），我们将在广泛的健康成年人（年龄30-89）中研究与年龄相关的热痛处理差异及其潜在的神经生理学。我们还将获得静息状态功能连接数据，用于二次分析，探索静息状态连接是否预测对热痛的心理物理和神经生理反应。为了控制与衰老相关的血流改变的影响，我们将采集静息状态动脉自旋标记MRI（ASL）数据，以量化静息脑血流量（CBF）。我们将在疼痛、衰老和性的神经模型的背景下解释这些发现。我们的总体假设是，年龄相关的神经系统变化导致抑制回路的改变，调节疼痛相关的不愉快，这使得老年人，特别是女性，在受伤后检测疼痛的风险降低，疼痛治疗不足的风险增加，慢性疼痛的风险增加。改变的感觉和情感处理对年龄相关和性别特异性疼痛评估和管理策略有影响。最近的进展，在评估实验疼痛使用功能磁共振成像提供了一个重要的基础，我们的长期目标是确定如何老化影响疼痛处理的心理物理学和神经生物学，并使用此信息作为正常的基线数据，为未来的R 01研究，包括老年人疼痛的条件，通知改善预防，评估和治疗策略。