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年中，肩袖撕裂的个体的临床结局并没有显着改善，这是 对于每年寻求肩袖撕裂的医疗服务的450万美国人来说，这是有问题的。我们的长期 目标是通过识别最有可能受益的患者来最大化功能恢复 来自目标疼痛干预措施。这些知识对于优化受损疼痛的治疗是必要的 加工。我们的中心假设是，神经系统在症状严重程度和 恢复比传统上所相信的。该假设的理由是基于 肩袖结构损伤和疼痛严重程度以及结构程度之间的不良关系 损坏（即撕裂尺寸，缩回等）和功能恢复。 Pozzi博士，具有专业知识的物理治疗师 生物力学和运动科学将通过接近肩袖泪来将他的研究朝着新的方向发展 从疼痛和神经科学的角度来看。 Pozzi博士以广泛的临床，疼痛为组装团队 神经影像学和疼痛神经科学专业知识，通过三个特定目的测试其中心假设：1）测试 肩部手机期间的大脑功能之间的关联，损伤的慢性和临床疼痛之间的关联 肩袖撕裂的人的症状； 2）测试疼痛表型之间的关系，慢性 肩袖撕裂的个体的损伤和临床疼痛症状； 3）测试基线的效用 处置性状，定量感觉测试和大脑功能可预测肩袖修复后的恢复。 该应用具有创新性，因为我们将招募肩袖撕裂的三种伤害病因（创伤性 - 有症状，慢性症状和无症状），这在研究慢性疼痛方面具有关键优势。 我们独特地阐明了神经系统对肌腱的突然和慢性丧失的反应 结构完整性，有和没有疼痛症状。我们有潜力测试特定的中心特征 急性肩袖诱导的疼痛可能会变得慢性。我们设计了一个新颖的实验，我们将 在精确控制的次级等肩肩收缩期间获取功能性大脑图像。我们将 阐明影响与主要临床相关的运动区域运动诱发的疼痛的因素 症状，因此提供了潜在干预目标的证据。我们的研究将提供重要的 通过确定可能影响患者预后变异性的其他因素来做出贡献。此外，我们的 调查结果将使我们朝着这一调查的长期目标迈进：告知精度疼痛医学 考虑到肩袖撕裂的个体中特定的疼痛表型。获得的知识 这项研究不会递增；它将在治疗肩袖撕裂的患者方面发生范式转移。

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