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.

项目概要 肌筋膜疼痛综合征（MPS）仍然是一个特征不明的疾病。尽管影响了数百万人 对于个人而言，我们不了解其发展、持续和发展的基本机制。 对治疗的反应，包括使用常见疗法，如触发点 (TrP) 注射、干针刺、 和肌筋膜释放。改进评估 MPS 的方法，包括活跃期和潜伏期及其 需要对治疗做出反应，不仅是为了提高我们的诊断能力，也是为了更好地理解 MPS 的起源和量化治疗效果。在本研究中，我们建议应用三种方法 MPS 和 TrP 定量评估，据我们所知，其中两个从未被使用过 在此背景下之前。第一种是电阻抗肌动描记法 (EIM)，这是一种最近开发的方法， 使用定向甚高频电流非侵入性地表征肌肉组织 非侵入性地了解组织的组织学特征和结构。它已被证明对 肌纤维肥大或萎缩或其他病理性疾病的情况 存在纤维化等变化。该技术的优点是完全无痛、快速 适用于肌肉的离散区域，甚至可以在家进行。第二种方法，肌纤维 阈值跟踪（TT）兴奋性测试，通过使用单个肌纤维来评估肌纤维的相对兴奋性 小针电极提供调节刺激，然后提供测试刺激。条件刺激 增加肌纤维的传导速度，从而可以方便地测量兴奋性 在 TrP 内。已证明它对影响肌纤维功能的多种条件很敏感。这 第三种方法，超声剪切波弹性成像 (SWE)，已在 MPS 中进行了一定程度的研究 并提供对肌肉组织刚性的深入了解，并将为这些其他组织提供有价值的比较 两项技术。在拟议工作的 R61 阶段，我们将研究活跃和潜在的患者 MPS 影响上斜方肌，以及一组使用这三种方法的健康受试者 建立小组之间的差异、技术的可重复性以及它们之间的关系（目标 分别为 1a、1b 和 1c）及其与标准疼痛评分的关系。根据我们的批准后 R61里程碑，在R33阶段（目标2），我们将在临床试验中使用所有三种方法来评估 TrP 干针疗法对一组影响上斜方肌的活动性 MPS 患者的有效性。电子信息管理 结果将作为主要的关注结果，数据在诊所和现场收集 家。在这项工作结束时，我们将确定这些技术的用途 评估 MPS，提供对潜在机制的新见解和方便的新生物标志物 预测和评估治疗干预的益处。