Intrathecal Baclofen and Pain Outcomes in Cerebral Palsy

鞘内注射巴氯芬与脑瘫的疼痛结果

• 批准号: 8640964
• 负责人: FRANK J SYMONS
• 金额: $ 47.49万
• 依托单位: UNIVERSITY OF MINNESOTA
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-04-01 至 2018-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8640964
• 关键词: Accounting; Activities of Daily Living; Address; Analgesics; Baclofen; Belief; Biological; Biological Markers; Caregivers; Catheters; Cerebral Palsy; Cerebrospinal Fluid; Characteristics; Child; Chronic; Chronic disabling pain; Clinical; Cognitive; Congenital musculoskeletal anomalies; Data; Decision Making; Distress; Dose; Equilibrium; Failure; Family; Family member; Frequencies; Goals; Health Personnel; Immune; Impairment; Implant; Individual Differences; Inflammation; Inflammatory; Knowledge; Life; Measurement; Measures; Modeling; Motor; Muscle Contraction; Muscle Spasticity; Muscular Dystrophies; Musculoskeletal; Neurodevelopmental Disability; Neurodevelopmental Disorder; Neurosecretory Systems; Nociception; Operative Surgical Procedures; Outcome; Pain; Pain Nature; Pain Research; Pain management; Patient Selection; Patients; Physiological; Physiology; Population; Procedures; Process; Proxy; Psychosocial Factor; Public Health; Pump; Quality of life; Reporting; Research; Rett Syndrome; Risk; Sampling; Schedule; Scientific Advances and Accomplishments; Selection Criteria; Seroma; Severities; Stress; Structure; Subgroup; Syndrome; System; Testing; Treatment outcome; Vulnerable Populations; Withdrawal; Work; Wound Infection; bench to bedside; chronic pain; clinical decision-making; clinically relevant; design; disability; experience; functional outcomes; improved; innovation; insight; novel; primary outcome; prospective; psychosocial; public health relevance; response; treatment effect

DESCRIPTION (provided by applicant): This application addresses PA 10-006 Mechanisms, Models, Measurement, and Management in Pain Research (R01). The majority of children with cerebral palsy (CP) live with spasticity and spasticity-induced disabling chronic pain. One of the front-line treatments for spasticity involves surgically implanting a pump to intrathecally deliver baclofen (ITB). Doing so avoids the problems with orally administered baclofen but creates problems of its own including general surgical risks but also procedure specific issues such as cerebral spinal fluid (CSF) leaks and catheter malfunction leading to serious withdrawal complications. Thus, the procedure is not without risk, but on balance the evidence is tilted toward efficacy for spasticity outcomes by reducing spasticity. It is less clear, however, whether the chronic pain is also and always reduced. There are mixed and muddled results specific to pain outcomes; mixed because in some studies pain is reported to decrease but in others there is no apparent change, muddled because the majority of the studies are poorly designed with pain poorly measured and so the results are scientifically uncertain and clinically ambiguous. This specific problem - whether or not pain improves following ITB treatment - is part of a much broader general issue - whether we can use scientific advances from pain research to improve our clinical understanding of pain and disability among children with significant intellectual, motor, and communicative impairments associated with neurodevelopmental disorders. The overall goal of this application is to initiate a line of research with the primary objective of improving our scientific understanding of changes in chronic pain in response to treatment among children with significant neurodevelopmental disabilities. The specific purpose of this interdisciplinary translational proposal is to clarify the clinical ambiguity in pain outcomes in relation to ITB treatment by prospectively studying a sample of children with CP and spasticity before and after ITB implant. By doing so, we will be able to (a) examine in detail the relation between changes in spasticity and pain, (b) evaluate whether pain that persists even in the presence of reduced spasticity will be associated with poorer functional outcomes, and (c) empirically test whether treatment parameters associated with the pump implant, clinical features associated with CP, or physiological variables associated with pain, stress, and inflammation interact to influence pain specific treatment outcomes. To date, there has been no comprehensive study specific to chronic pain among children with CP treated with ITB pump implants. Considering the vulnerable clinical population for the proposed project, we believe there is an urgent imperative to try to make scientific advances from the 'bench' relevant to real-world pain and disability problems. Ultimately, the knowledge gain should transfer into a clinical decision making aide with respect to improving patient selection criteria and by informing patients, their families, and healthcare providers more completely about the full range of expected outcomes with respect to pain and function.

描述（由申请人提供）：本申请涉及PA 10-006疼痛研究中的机制、模型、测量和管理（R01）。大多数脑瘫（CP）患儿伴有痉挛和痉挛引起的致残性慢性疼痛。痉挛的一线治疗方法之一是通过手术植入一个泵来进行鞘内输送