Central Sensitization and Sleep Disturbance as Predictors of Treatment Outcomes in Patients with Knee Osteoarthritis

中枢敏化和睡眠障碍作为膝骨关节炎患者治疗结果的预测因子

• 批准号: 10663903
• 负责人: Claudia Michelle Campbell
• 金额: $ 41.03万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-08-01 至 2025-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10663903
• 关键词: Advocate; Affect; Ancillary Study; Behavioral; Body mass index; Caring; Central Nervous System; Clinical; Coping Skills; Degenerative polyarthritis; Economic Burden; Effectiveness; Elderly; Equipment; Evaluation; Funding; Future; Goals; Heterogeneity; High Prevalence; Hyaluronic Acid; Hyperalgesia; Hypersensitivity; Impairment; Individual; Individual Differences; Injections; Injury; Intervention; Knee Osteoarthritis; Knee joint; Knowledge; Laboratories; Life Expectancy; Link; Literature; Longterm Follow-up; Maintenance; Measures; Modeling; Nerve; Nerve Block; Nociception; Operative Surgical Procedures; Opioid; Outcome; Outcome Measure; Pain; Pain Disorder; Pain management; Patient Outcomes Assessments; Patients; Pattern; Peripheral; Persistent pain; Persons; Phase; Phenotype; Physical Function; Population; Prediction of Response to Therapy; Procedures; Public Health; Questionnaires; Radiofrequency Interstitial Ablation; Randomized, Controlled Trials; Recommendation; Refractory; Reporting; Resources; Risk; Role; Selection for Treatments; Sensory; Severities; Shapes; Site; Sleep; Sleep Apnea Syndromes; Sleep Deprivation; Sleep disturbances; Sleeplessness; Societies; Symptoms; Testing; Time; Treatment outcome; central sensitization; chronic pain; chronic painful condition; clinical pain; compare effectiveness; design; disability; duloxetine; effective intervention; experience; functional disability; global health; improved; improved outcome; indexing; joint mobilization; knee replacement arthroplasty; neurotransmission; opioid therapy; osteoarthritis pain; pain chronification; pain model; pain processing; parent project; patient response; patient subsets; pharmacologic; poor sleep; precision medicine; predicting response; radiological imaging; recruit; response; skills training; standard care; theories; transmission process; treatment comparison; treatment response

PROJECT SUMMARY/ABSTRACT Knee osteoarthritis (KOA) is one of the leading causes of chronic pain and disability worldwide, affecting over 30% of older adults, and represents a major global health and economic burden to individuals and society. The rates of KOA have more than doubled in the past 70 years and continue to grow sharply, given increases in life expectancy and population BMI. Surgery is often used to treat KOA, but is associated with a high rate of persistent pain and is not a permanent solution. Numerous nonsurgical therapies have been advocated to treat pain in patients with KOA. A growing literature documents enhanced central nervous system pain processing, known as central sensitization (CS), which produces widespread sensitivity, among KOA patients. Sleep disturbance is associated with CS but imparts a terrible burden on patients suffering from pain in its own right. Both CS and sleep disturbance are hallmarks of various chronic pain conditions and important treatment considerations, with both independently being associated with the initiation and maintenance of pain and heightening pain severity . The parent project, which provides the platform for the current proposal, will evaluate behavioral, pharmacologic, and procedural interventions for KOA; a step-care model that allows for multiple treatment comparisons and phenotyping to improve selection for each therapy, which is expected to refine outcomes and reduce unnecessary interventions. The results of this study, which will follow pragmatic principles in order to maximize the information provided to stakeholders, will address not only the effectiveness of each tested intervention but also provide meaningful information regarding effectiveness across key subgroups of patients. However, the parent project will not assess CS or sleep disturbance, due to the additional expertise, expense, equipment and time required. A mechanistic evaluation of these factors is required to substantiate their impact on treatment response. The current proposal seeks to substantiate whether the conceptual understanding of these factors is legitimate. The project will also evaluate whether advanced understanding of CS and sleep disturbance are important contributions on top of the more easily quantified phenotypes collected in the parent project. The knowledge gained will inform patient phenotyping to better match patients with effective interventions, ultimately reducing the substantial heterogeneity across intervention outcomes and reliance on opioid therapies.

项目总结/文摘