Electrophysiological and ultrasound quantitative biomarkers for myofascial pain

肌筋膜疼痛的电生理学和超声定量生物标志物

• 批准号: 10569720
• 负责人: Seward B. Rutkove
• 金额: $ 235.16万
• 依托单位: BETH ISRAEL DEACONESS MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-19 至 2025-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10569720
• 关键词: Acidosis; Affect; Aftercare; Area; Assessment tool; Atrophic; Biological Markers; Blood Vessels; Chronic; Clinic; Clinical; Clinical Trials; Clinical Trials Design; Clinical assessments; Connective Tissue; Data; Development; Diagnosis; Diagnostic; Disease; Documentation; Double-Blind Method; Electrodes; Electrophysiology (science); Evaluation; Fibrosis; Frequencies; General Hospitals; Health; Histologic; Home; Hypertrophy; Individual; Injections; Intervention; Ischemia; Israel; Lymphatic; Machine Learning; Massachusetts; Measurement; Measures; Medical center; Methodology; Methods; Modality; Modulus; Monitor; Muscle; Muscle Contraction; Muscle Fibers; Muscle Rigidity; Myofascial Pain Syndromes; Myography; Needles; Nerve; Neuropathy; Nociception; Outcome; Pain; Pain Clinics; Pain Measurement; Painless; Palpation; Participant; Pathologic; Patients; Performance; Peripheral; Phase; Phenotype; Physicians; Physiology; Procedures; Reporting; Reproducibility; Speed; Stimulus; Structure; Surrogate Endpoint; Techniques; Technology; Technology Assessment; Testing; Therapeutic Intervention; Tissues; Training; Variant; Visit; Work; base; central sensitization; conditioning; diagnostic biomarker; diagnostic value; disability; effectiveness evaluation; elastography; electric impedance; improved; insight; interest; nerve supply; neuroinflammation; pain reduction; pain score; predictive marker; prescription pain reliever; primary outcome; programs; psychologic; quantitative ultrasound; randomized controlled study; recruit; response; response biomarker; secondary outcome; spontaneous pain; tool; trapezius muscle; treatment effect; treatment response; trigger point; ultrasound

Project Summary Myofascial pain syndrome (MPS) remains a poorly characterized entity. Although affecting millions of individuals, we do not understand the basic underlying mechanisms of its development, persistence, and response to therapy, including the use of common therapies such as trigger point (TrP) injection, dry needling, and myofascial release. Improved methods of assessing MPS, both in its active and latent phases, and its response to therapy are needed, not only to improve our diagnostic capabilities but also to better understand MPS’ origins and for quantifying the effect of treatment. In this study, we propose to apply three methodologies to the assessment of MPS and TrP quantification, two of which, to our knowledge, have never been used before in this context. The first, electrical impedance myography (EIM), a recently developed method that characterizes muscle tissue non-invasively using directed, very high-frequency, electrical current provides insights into tissue histological features and structure non-invasively. It has been shown to be sensitive to conditions in which muscle fibers are hypertrophied or atrophied or in which disease other pathological changes, such as fibrosis, are present. An advantage of this technique is that it is entirely painless, rapid to apply to discrete areas of muscle, and can even be performed at home. The second method, myofiber threshold tracking (TT) excitability testing, assesses the relatively excitability of myofibers by using a single small needle electrode to provide a conditioning stimulus followed by a test stimulus. The conditioning stimulus increases the speed of conduction in the myofibers and can thus provide a convenient measure of excitability within a TrP. It has already proven to be sensitive to a number of conditions impacting myofiber function. The third method, ultrasound with shear wave elastography (SWE), has been studied to some extent in MPS and provides insight into the rigidity of the muscle tissue and will provide a valuable comparator to these other two technologies. In the R61 phase of the proposed work, we will study patients with both active and latent MPS affecting the upper trapezius, as well as a group of healthy subjects with these three methodologies to establish differences between groups, repeatability of the techniques, and the relationships across them (Aims 1a, 1b, and 1c, respectively) and their relationship to standard pain scores. After approval based on our R61milestones, in the R33 phase (Aim 2), we will use all three methods in a clinical trial assessing the effectiveness of TrP dry needling in a group of patients with active MPS affecting the upper trapezius. EIM outcomes will serve as the primary outcome of interest, with data being collected both in the clinic and at home. At the conclusion of this work, we will have established the use of these technologies for the assessment MPS, providing new insights into underlying mechanisms and convenient new biomarkers to predict and assess the benefit of therapeutic intervention.

项目摘要 肌筋膜疼痛综合征（MPS）仍然是一个特征性的实体。虽然影响了数百万 个人，我们不了解其发展，持久性和 对治疗的反应，包括使用常见疗法，例如触发点（TRP）注射，干针刺， 和肌筋膜释放。改进了在其活性阶段和其潜在阶段评估MP的方法，其 需要对治疗的反应，不仅可以提高我们的诊断能力，而且还需要更好地理解 国会议员的起源和量化治疗的影响。在这项研究中，我们建议采用三种方法 评估MPS和TRP量化的评估，据我们所知，其中两个从未被使用过 在这种情况下。第一个，电阻抗myagraphy（EIM），一种最近开发的方法，该方法 角色使用定向的，非常高频的电流提供非侵入性的肌肉组织 深入了解组织组织学特征和无创结构。已证明它对 肌肉纤维肥厚或萎缩或疾病其他病理的疾病 存在诸如纤维化之类的变化。该技术的一个优点是它完全痛苦，迅速 应用于离散的肌肉区域，甚至可以在家中进行。第二种方法，肌纤维 阈值跟踪（TT）兴奋性测试，通过使用单个来评估肌纤维的相对兴奋性 小针电电极提供调节刺激，然后进行测试刺激。调节刺激 提高肌纤维的传导速度，因此可以提供方便的兴奋度量 在TRP中。它已经证明对影响肌纤维功能的许多条件很敏感。这 第三种方法，具有剪切波弹性图（SWE）的超声波 并提供有关肌肉组织刚度的洞察力，并将为其他这些提供有价值的比较器 两种技术。在拟议工作的R61阶段，我们将研究活跃和潜在的患者 影响上斜方肌的国会议员，以及一组健康受试者，这三种方法 建立群体之间的差异，技术的可重复性以及跨越的关系（目的 1A，1B和1C）及其与标准疼痛评分的关系。根据我们的批准后 R33阶段（AIM 2）R61Milestones，我们将在临床试验评估中使用所有三种方法 TRP干点在一组有活性MP的患者中影响上斜方肌的有效性。 EIM 结果将作为感兴趣的主要结果 家。在这项工作结束时，我们将确定这些技术的使用 评估国会议员，为基本机制和方便的新生物标志物提供新的见解 预测和评估治疗干预的好处。