University of Michigan BACPAC Mechanistic Research Center

项目总结/摘要 慢性下背痛（cLBP）是非常普遍的，昂贵的，并与长期功能性疼痛相关。 损伤、残疾和生活质量差。几种药理学（例如度洛沙汀和加巴喷丁）和 非药物治疗，如物理治疗，穴位按摩和正念干预 （MBIs）在cLBP中显示出疗效。正念减压（Mindfulness-Based Stress-Reduction，MBSR）是一个很好的例子。 越来越广泛地使用非药物干预来减轻疼痛，现在建议在 许多治疗CLBP的指南。然而，尽管研究显示对cLBP有效，但只有一个子集 对每种治疗方式都有反应。迫切需要更好地了解 疼痛机制和对不同治疗反应的预测因素，目标是根据以下因素匹配患者： 表型与他们最有可能响应的疗法。父母奖，一个治愈倡议奖 (U19 AR 076734），它使用精确医学方法来确定哪些治疗可能在 不同的患者内型。拟议的补充将允许我，一个临床风湿病学家，学习 这些技能通过评估正念减压对患者报告的疼痛干扰cLBP。我也能 使用临床可用数据（如患者报告的结局）以及最新的表型分析 功能性磁共振成像（fMRI）和定量感觉测试（QST）等方法，以机械地探索 正念减压疗法的神经生物学效应我随后将能够将这些知识转化为如何 管理MBSR以及评估自身免疫性风湿病患者的疼痛机制 疾病，并评估对不同疗法最有反应的患者表型。

Project Summary / Abstract Chronic low back pain (cLBP) is highly prevalent, expensive and is associated with long term functional impairment, disability and poor quality of life. Several pharmacologic (e.g. duloxetine and gabapentin) and non-pharmacologic treatments such as physical therapy, acupressure and mindfulness-based interventions (MBIs) have shown efficacy in cLBP. Mindfulness-Based Stress-Reduction (MBSR) is an example of an increasingly widely used non-pharmacological intervention for pain reduction, and is now recommended in many treatment guidelines for cLBP. However, despite studies displaying effectiveness in cLBP, only a subset of individuals responds to each treatment modality. There is an urgent need for a greater understanding of pain mechanisms and predictors of response to different therapies with a goal of matching patients based on phenotypes to therapies to which they are most likely to respond. The parent award, a HEAL Initiative award (U19 AR076734), which uses a precision medicine approach to identify what treatments are likely to work in different patient endotypes. The proposed supplement will allow the me, a clinical rheumatologist, to learn these skills through assessment of MBSR on patient-reported pain interference in cLBP. I will also be able to use both clinically available data (such as patient-reported outcomes) as well as state-of-art phenotyping methods such as functional MRI (fMRI) and Quantitative Sensory Testing (QST), to mechanistically explore the proposed neurobiological effects of MBSR. I will subsequently be able to translate this knowledge in how to administer MBSR as well as evaluating pain mechanisms in individuals with autoimmune rheumatologic diseases, and evaluate the patient phenotypes most responsive to different therapies.