Nervous system influences on recovery from painful rotator cuff tears

神经系统对肩袖撕裂疼痛恢复的影响

• 批准号: 10629671
• 负责人: Federico Pozzi
• 金额: $ 55.59万
• 依托单位: UNIVERSITY OF FLORIDA
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-05-10 至 2028-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10629671
• 关键词: Acute; Address; Affect; Affective; American; Area; Biomechanics; Brain; Brain imaging; Brain region; Caring; Chronic; Clinical; Cognitive; Data; Disease; Dissociation; Etiology; Foundations; Goals; Impairment; Individual; Injury; Intervention; Investigation; Isometric Exercise; Kinesiology; Knowledge; Measures; Medical; Medicine; Mission; Motor; Movement; Musculoskeletal Diseases; National Institute of Arthritis, and Musculoskeletal, and Skin Diseases; Nervous System; Neurosciences; Operative Surgical Procedures; Outcome; Pain; Pain Research; Patient Outcomes Assessments; Patient-Focused Outcomes; Patients; Pattern; Phenotype; Play; Positioning Attribute; Prevention; Public Health; Reaction; Recovery; Recovery of Function; Research; Research Project Grants; Rest; Role; Rotator Cuff; Sensory; Severities; Shoulder; Stimulus; Strategic Planning; Symptoms; Tendon structure; Testing; Traction; chronic musculoskeletal pain; chronic pain; clinical pain; clinically relevant; cognitive modulation of pain; design; experimental study; follow-up; improved; individualized medicine; innovation; muscular structure; neuroimaging; novel; pain processing; pain sensitivity; pain symptom; physical therapist; recruit; repaired; response; rotator cuff tear; shoulder injury; trait; treatment optimization; treatment response

PROJECT SUMMARY In the last 30 years, clinical outcomes for individuals with rotator cuff tears have not substantially improved, which is problematic for the 4.5 million Americans that seek medical care for rotator cuff tears each year. Our long-term goal is to maximize functional recovery following rotator cuff tears by identifying patients most likely to benefit from targeted pain interventions. This knowledge is necessary to optimize treatments of impaired pain processing. Our central hypothesis is that the nervous system plays a larger role in symptom severity and recovery than conventionally believed. The rationale for this hypothesis is based on the disconnect between the rotator cuff structural damage and pain severity and the poor relationship between the extent of structural damage (i.e., tear size, retraction, etc.) and functional recovery. Dr. Pozzi, a physical therapist with expertise in biomechanics and movement science, will take his research in a new direction by approaching rotator cuff tears from pain and neuroscience perspectives. Dr. Pozzi assembled a team with extensive clinical, pain, neuroimaging, and pain-neuroscience expertise to test his central hypothesis through three specific aims: 1) test the association between brain function during a shoulder motor-task, chronicity of injury, and clinical pain symptoms in individuals with rotator cuff tears; 2) test the relationship between pain phenotypes, chronicity of injury, and clinical pain symptoms in individuals with rotator cuff tears; and 3) test the utility of baseline dispositional traits, quantitative sensory testing, and brain function to predict recovery following rotator cuff repair. This application is innovative because we will recruit the three injury etiologies of rotator cuff tears (traumatic- symptomatic, chronic-symptomatic, and asymptomatic), which provide a key advantage in studying chronic pain. We are uniquely positioned to shed light on how the nervous system reacts to sudden and chronic loss of tendon structural integrity with and without pain symptoms. We have the potential to test specific central features of acute rotator cuff-induced pain that may become chronic. We designed a novel experiment in which we will acquire functional brain images during precisely controlled submaximal isometric shoulder contractions. We will elucidate factors influencing movement-evoked pain of body areas associated with the primary clinical symptoms, thus providing evidence of potential intervention targets. Our study will provide a significant contribution by identifying additional factors that may influence the variability in patient outcomes. Further, our findings will move us toward the long-term goals of this line of investigation: informing precision pain medicine with consideration for specific pain phenotypes in individuals with rotator cuff tears. The knowledge gained in this study will not be incremental; it will springboard a paradigm shift in treating patients with rotator cuff tears.

项目摘要 在过去的30年里，肩袖撕裂患者的临床结局没有实质性改善， 对于每年因肩袖撕裂而寻求医疗护理的450万美国人来说是个问题。我们的长期 目标是通过识别最有可能受益的患者，最大限度地恢复肩袖撕裂后的功能 有针对性的疼痛干预。这些知识对于优化受损疼痛的治疗是必要的 处理.我们的中心假设是，神经系统在症状的严重程度中起着更大的作用， 比传统上认为的要好。这一假设的基本原理是基于 肩袖结构性损伤与疼痛的严重程度和结构性差的程度之间的关系 损坏（即，撕裂尺寸、回缩等）功能恢复。Pozzi博士是一位物理治疗师， 生物力学和运动科学，将把他的研究在一个新的方向，接近肩袖撕裂 从疼痛和神经科学的角度。Pozzi医生组建了一个团队， 神经影像学和疼痛神经科学专业知识，通过三个具体目标来测试他的中心假设：1）测试 肩关节运动任务期间脑功能、损伤慢性化和临床疼痛之间的关系 肩袖撕裂患者的症状; 2）测试疼痛表型，慢性疼痛和疼痛之间的关系。 损伤和临床疼痛症状; 3）测试基线的效用 性格特征、定量感觉测试和脑功能来预测肩袖修复后的恢复。 该应用是创新的，因为我们将招募肩袖撕裂的三种损伤病因（创伤性- 有症状的、慢性-有症状的和无症状的），这在研究慢性疼痛中提供了关键优势。 我们是唯一的定位，以阐明神经系统如何反应突然和慢性损失的肌腱 结构完整，有或没有疼痛症状。我们有可能测试特定的核心特征， 急性肩袖引起的疼痛可能会变成慢性。我们设计了一个新颖的实验， 在精确控制的次最大等长肩部收缩期间获取功能性脑图像。我们将 阐明影响运动诱发疼痛的主要临床相关的身体部位的因素 症状，从而提供潜在干预目标的证据。我们的研究将提供一个重要的 通过识别可能影响患者结局变异性的其他因素，来评估其贡献。此外，我们的 这些发现将使我们朝着这一研究方向的长期目标前进： 并考虑到患有肩袖撕裂的个体中的特定疼痛表型。获得的知识 这项研究不会是增量的，它将成为治疗肩袖撕裂患者的范式转变的跳板。

项目成果

Do Patients with Chronic Spinal Pain and Comorbid Insomnia Have More Features of Central Sensitization? A Case-Control Study.

• DOI: 10.3390/healthcare11243152
• 发表时间: 2023-12-12
• 期刊: HEALTHCARE
• 影响因子: 2.8
• 作者: Araujo Almeida, Lucas;Bilterys, Thomas;Van Looveren, Eveline;Mairesse, Olivier;Cagnie, Barbara;Meeus, Mira;Moens, Maarten;Goubert, Dorien;Munneke, Wouter;Danneels, Lieven;Ickmans, Kelly;Rezende Camargo, Paula;Nijs, Jo;Malfliet, Anneleen;De Baets, Liesbet
• 通讯作者: De Baets, Liesbet