The interaction between analgesic medication and exercise-induced musclehypertrophy in patients with low back pain

下背痛（LBP）是一种复杂的疾病，影响65-85%的人口，是最主要的疾病。 在美国，肌肉骨骼疾病导致残疾。百分之七十五的 接受这种病症治疗的个体经历了以下形式的次优或差的结果： 残疾和功能缺陷，包括腰部肌肉组织的力量和耐力。 慢性LBP患者最常见的初始治疗是基于运动的康复， 以及镇痛药物形式的药物管理。虽然这两 保守治疗方式往往同时规定，镇痛剂的影响， 药物对肌肉适应运动能力的影响尚不清楚。重要的是在 健康的个体，这些药物中的一些已被证明可以抑制肌肉蛋白质合成， 代谢和干细胞功能。药物的影响可以解释肌肉的变异性- 与该人群中运动康复相关的具体和临床结果。到 为了解决目前文献中的这些空白，我们建议定义药物使用模式和临床 参与基于运动的慢性腰痛患者的结果 康复计划。具体目标1将研究症状干扰的影响， 心理社会因素，以及与运动相关的镇痛药物使用的诊断 LBP。具体目标2将评估药物类型、剂量和时间对运动的影响 性能最后，具体目标3将确定药物类型、剂量和时间是否影响 完成12周抵抗后肌肉肥大的程度和临床结局 锻炼计划。确定常见镇痛药物对肌肉肥大的影响， 运动表现和临床结果是优化保守治疗的重要一步， 下腰痛患者的治疗这些信息也将适用于各种 采用类似治疗策略的肌肉骨骼疾病。这种贡献 意义重大，因为这是精准医学方法的第一步，旨在建立适当的 以及有针对性的运动和止痛药物处方，用于逆转肌肉损伤， 阻碍患者康复。这一提议具有创新性，因为它旨在填补知识上的一个巨大空白 关于止痛药对疼痛患者肌肉适应性的影响， 病理性肌肉

Low back pain (LBP) is a complex condition that affects 65-85% of the population, and is the leading musculoskeletal condition contributing to disability in the United States. Seventy-five percent of individuals undergoing treatment for this condition experience suboptimal or poor outcomes in the form of disability and deficits in functional capacity, including strength and endurance of the lumbar musculature. The most common initial treatments for individuals with chronic LBP are exercise-based rehabilitation, and pharmacological management in the form of analgesic medications. Although these two conservative treatment modalities are often concurrently prescribed, the influence of analgesic medications on the capacity of muscle to adapt in response to exercise is unknown. Importantly, in healthy individuals, some of these medications have been shown to inhibit muscle protein synthesis, metabolism, and stem cell function. The influence of medications may explain the variability in muscle- specific and clinical outcomes associated with exercise-based rehabilitation in this population. To address these current gaps in the literature, we propose to define medication usage patterns and clinical outcomes across individuals with chronic low back pain who are participating an exercise-based rehabilitation program. Specific Aim 1 will investigate the influence of symptom interference, psychosocial factors, and diagnosis on analgesic medication use relative to exercise in individuals with LBP. Specific Aim 2 will evaluate the influence of medication type, dose, and timing on exercise performance. Finally, Specific Aim 3 will determine if medication type, dose, and timing influences the magnitude of muscle hypertrophy and clinical outcomes after completion of a 12-week resistance exercise program. Determining the impact of common analgesic medications on muscle hypertrophy, exercise performance, and clinical outcomes is an important step in optimizing conservative management in individuals with low back pain. This information will also be applicable to a variety of musculoskeletal conditions for which similar treatment strategies are employed. This contribution is significant because it is the first step in a precision medicine approach aimed at establishing appropriate and targeted exercise and analgesic medication prescriptions for reversing muscle impairments that obstruct patient recovery. This proposal is innovative because it aims to fill a large gap in knowledge regarding the influence of analgesic medication on muscle adaptation in individuals with pain and pathological muscle.