Effects of Chronic Pain, Dyspnea, and Physical Activity Promotion on Functional Connectivity of the Brain in COPD

慢性疼痛、呼吸困难和体力活动促进对慢性阻塞性肺病患者大脑功能连接的影响

• 批准号: 10839756
• 负责人: Marilyn L. Moy
• 金额: --
• 依托单位: VA BOSTON HEALTH CARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-07-01 至 2024-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10839756
• 关键词: Affect; Award; Behavior; Biological Markers; Biology; Brain; Brain region; Cause of Death; Chronic Obstructive Pulmonary Disease; Clinical; Clinical Management; Communication; Complement; Complex; Couples; Disease; Dyspnea; Education; Elderly; Enrollment; Etiology; Event; Exercise; Feedback; Frontal gyrus; Funding; Future; Goals; Healthcare; Human; Inferior; Informal Social Control; Intervention; Magnetic Resonance Imaging; Measures; Medial; Mediating; Medical; Motivation; Musculoskeletal Pain; Narcotics; Nonpharmacologic Therapy; Opiate Addiction; Pain; Pain management; Parietal Lobe; Participant; Patient Care; Patient Self-Report; Patients; Perception; Persons; Physical Exercise; Physical activity; Questionnaires; Randomized; Reporting; Research; Rest; Safety; Self Management; Sensory; Social support; Stimulus; Symptoms; Techniques; Technology; Testing; Veterans; Work; accurate diagnosis; accurate diagnostics; chronic back pain; chronic musculoskeletal pain; chronic pain; clinically relevant; deconditioning; design; diagnostic tool; exercise intervention; experience; functional status; health related quality of life; improved; insight; neuroimaging; novel; novel marker; online community; pain perception; pedometer; personalized care; personalized medicine; physical inactivity; respiratory; response; symptom management; symptom treatment; theories; treatment optimization; web site

COPD is the nation's third leading cause of death and affects up to 11% of all VA healthcare patients. Patients with COPD experience significant dyspnea despite optimization of medical therapy. In addition, over half of patients with COPD experience chronic pain--largely musculoskeletal pain. Clinically, in patients who suffer from both chronic pain and dyspnea, it is difficult to distinguish a patient's perception of one symptom modulated by the other. Novel objective diagnostic tools are needed to complement patient self-report and accurately distinguish symptoms in patients who have both chronic pain and dyspnea to optimize clinical management. It is also important to study chronic pain and dyspnea in COPD because they are common barriers to engaging in physical activity (PA) and exercise. The clinical course of COPD is characterized by a downward spiral of dyspnea and chronic pain, physical inactivity, and significant functional limitation. Although chronic pain and dyspnea can be barriers, PA and exercise are powerful, but underused, non-addictive therapies for management of these symptoms in COPD. We developed Every Step Counts (ESC), a technology-mediated intervention based on the Theory of Self-Regulation, to promote PA in COPD. We have demonstrated ESC's safety, feasibility, and efficacy to increase PA and improve health-related quality of life in Veterans with COPD. In two separate studies using questionnaires, ESC has been shown to improve dyspnea in COPD and relieve chronic back pain in Veterans. An important next step is to understand the mechanisms of benefit of PA interventions, like ESC, in the many COPD patients with both chronic musculoskeletal pain and dyspnea to ultimately design better PA interventions and optimize treatment of these symptoms. Currently, the central mechanisms of chronic pain and dyspnea, and how they change in response to PA promotion in COPD are largely unknown. It has been shown that pre-stimulus resting state functional connectivity determines pain perception in healthy humans. Resting state fcMRI evaluates interactions between brain regions before a sensory event or when an explicit task is not being performed. These communications are altered in older adults with chronic musculoskeletal pain. Functional connectivity among regions specifically within the “default mode” network (DMN) (posterior cingulate, inferior parietal lobes, and medial frontal gyrus) have been examined in clinical disease states, as this network is reliably detected and well-characterized. Functional connectivity may be a novel biomarker of chronic pain and dyspnea. Aim 1: Characterize and correlate the relationship between functional connectivity and chronic musculoskeletal pain and dyspnea in 30 persons with COPD (10 with both symptoms, 10 with chronic pain, and 10 with dyspnea). Aim 2: Explore changes in functional connectivity and changes in symptoms in 30 persons with COPD after use of the ESC intervention to increase PA. Our proposed design will leverage enrollment of well- characterized participants with COPD already using the ESC PA intervention as part of a distinct and ongoing RR&D Merit Award. This proposal will provide insight into the biologically complex relationships between symptoms (chronic pain and dyspnea), behavior (PA), and biology at the central level (functional connectivity).

慢性阻塞性肺病是美国第三大致死原因，影响了所有退伍军人管理局医疗保健患者的11%。 尽管优化了药物治疗，COPD患者仍会出现明显的呼吸困难。此外，完毕 一半的慢性阻塞性肺病患者经历慢性疼痛--主要是肌肉骨骼疼痛。临床上，在那些 同时患有慢性疼痛和呼吸困难，很难区分患者对一种症状的感知 被另一个人调制着。需要新的客观诊断工具来补充患者自我报告和 准确辨别慢性疼痛和呼吸困难患者的症状以优化临床 管理层。研究慢性阻塞性肺疾病的慢性疼痛和呼吸困难也很重要，因为它们是常见的 从事体育活动(PA)和锻炼的障碍。慢性阻塞性肺疾病的临床病程特点是 呼吸困难和慢性疼痛的螺旋式下降，身体缺乏活动，以及显著的功能障碍。虽然 慢性疼痛和呼吸困难可能是障碍，PA和锻炼是强大的，但没有得到充分利用，不会上瘾 治疗慢性阻塞性肺疾病这些症状的方法。我们开发了每一步都很重要(ESC)， 基于自我调节理论的技术中介干预，促进慢性阻塞性肺疾病患者的PA。我们有 证明了ESC在增加PA和改善健康相关生活质量方面的安全性、可行性和有效性 患有慢性阻塞性肺病的退伍军人。在两项使用问卷调查的独立研究中，ESC已被证明可以改善呼吸困难 治疗慢性阻塞性肺疾病，缓解退伍军人的慢性背痛。下一步重要的是要了解这些机制。 PA干预，如ESC，对许多既有慢性肌肉骨骼疼痛又有慢性肌肉骨骼疼痛的COPD患者的益处 和呼吸困难，以最终设计更好的PA干预措施，并优化这些症状的治疗。 目前，慢性疼痛和呼吸困难的中枢机制，以及它们如何改变对PA的反应 在慢性阻塞性肺疾病中的推广在很大程度上是未知的。已有研究表明，刺激前的静息状态起作用 连通性决定了健康人类的痛觉。静息状态fcMRI评估交互作用 在感觉事件之前或当一个明确的任务没有被执行时，大脑区域之间的差异。这些 患有慢性肌肉骨骼疼痛的老年人的通讯会发生变化。之间的功能连接 特别是“默认模式”网络(DMN)内的区域(后扣带回、顶下叶和 额叶内侧回)在临床疾病状态下进行了检查，因为该网络被可靠地检测到并 刻画得很好。功能连接可能是慢性疼痛和呼吸困难的一个新的生物标志物。目标1： 功能连通性与慢性肌肉骨骼疼痛的关系及其相互关系 30例慢性阻塞性肺疾病患者中，10例有两种症状，10例有慢性疼痛，10例有呼吸困难。 目的2：探讨30例慢性阻塞性肺疾病患者术后功能连通性的变化及症状变化 使用ESC干预以增加PA。我们建议的设计将利用Well- 描述了患有COPD的参与者已经使用ESC PA干预作为独特和持续的 RR&D功勋奖。这项提议将提供对生物上复杂的关系的洞察 中央层面的症状(慢性疼痛和呼吸困难)、行为(PA)和生物学(功能连接)。