Improving functions in Veterans with Post-Traumatic Peripheral Neuropathic Pain

改善患有创伤后周围神经性疼痛的退伍军人的功能

• 批准号: 9360010
• 负责人: ALBERT Y. LEUNG
• 金额: --
• 依托单位: VA SAN DIEGO HEALTHCARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-10-01 至 2019-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9360010
• 关键词: Adopted; Adverse effects; Affect; Analgesics; Area; Axon; Clinical Trials; Data; Esthesia; Excision; Foundations; Future; Healthcare Systems; Hypersensitivity; Injection of therapeutic agent; Injury; Intervention; Local Anesthetics; Magnetism; Measures; Methods; Multicenter Studies; Nature; Nerve Entrapment; Neuroma; Neurons; Operative Surgical Procedures; Pain; Pain management; Patients; Peripheral; Peripheral Nervous System Diseases; Peripheral nerve injury; Pharmaceutical Preparations; Phase; Procedures; Quality of life; Randomized Controlled Clinical Trials; Randomized Controlled Trials; Risk; Sensory; Services; Site; Spinal Ganglia; Steroids; Surveys; Trauma; Validation; Venous; Veterans; allodynia; improved; improved functioning; injured; nerve conduction study; painful neuropathy; reduce symptoms; spontaneous pain

Abstract Over 30% of neuropathic pain conditions in Veterans are due to peripheral nerve injury from physical or surgical related trauma. Peripheral nerve injury often results in the formation of neuroma/nerve entrapment, a persistent neuropathic pain state accompanied by sensory hypersensitivity and uncontrollable spontaneous pain sensation at the injury site. Current available medications for neuropathic pain often consist of untoward side effects and/or abusive risks. Invasive measures such as surgical resection or local injections of steroid and local anesthetics at the injury/neuroma site are often ineffective in alleviating the symptoms and the invasive nature of the procedure is usually painful for the patients. Therefore, there is a need in the field of pain management in developing means of non-invasive and non-contact therapy in treating post-traumatic peripheral neuropathic pain (PTP-NP) states. The pain service at the VA San Diego Healthcare System (VASDHS) has recently adopted the use of transcutaneous magnetic stimulation (tMS) in treating PTP-NP and noticed encouraging pain relief benefit in patients with PTP-NP. The PI also completed a mechanistic nerve conduction study and showed that this treatment method can potentially restore lost neuronal functions associated with PTP-NP. Our initial pilot data from a randomized controlled study support the feasibility of conducting a larger scale randomized controlled clinical trial to adequately assess the effect of tMS in treating PTP-NP and improving patients' function. To validate tMS as a non-contact and non-invasive pain treatment option for reducing pain in Veterans with PTP-NP and improving their overall functions, the proposed study will assess: 1) the effect of transcutaneous magnetic stimulation (tMS) in alleviating post-traumatic peripheral neuropathic pain (PTP-NP); 2) the effect of tMS in improving quality of life and functions in Veterans with PTP-NP.

摘要 退伍军人中超过30%的神经性疼痛是由于物理或物理损伤引起的周围神经损伤。 手术相关创伤周围神经损伤常导致神经瘤/神经卡压的形成， 持续性神经病理性疼痛状态，伴有感觉超敏反应和无法控制的自发性 在受伤部位的疼痛感。目前可用于神经性疼痛的药物通常包括不良反应， 副作用和/或滥用风险。侵入性措施，如手术切除或局部注射类固醇 并且在损伤/神经瘤部位的局部麻醉剂通常不能有效地减轻症状， 手术的侵入性通常使患者感到疼痛。因此，在疼痛领域需要 在发展创伤后非侵入性和非接触性治疗方法方面的管理 外周神经性疼痛（PTP-NP）状态。VA圣地亚哥医疗保健系统的疼痛服务 （VASDHS）最近采用经皮磁刺激（tMS）治疗PTP-NP， 注意到PTP-NP患者的疼痛缓解获益令人鼓舞。PI还完成了一个机械神经 传导研究，并表明这种治疗方法可以潜在地恢复失去的神经元功能 与PTP-NP有关。我们来自随机对照研究的初步试验数据支持 进行更大规模的随机对照临床试验，以充分评估tMS在治疗 PTP-NP和改善患者功能。验证tMS作为非接触和非侵入性疼痛治疗的有效性 减少PTP-NP退伍军人疼痛并改善其整体功能的选择，拟议的研究将 评估：1）经皮磁刺激（tMS）减轻创伤后的效果 周围神经性疼痛（PTP-NP）; 2）tMS在改善生活质量和功能方面的作用， PTP-NP的退伍军人。