Sleep and circadian rhythm disturbances as risk and progression factors for multiple chronic pain conditions

睡眠和昼夜节律紊乱是多种慢性疼痛的风险和进展因素

• 批准号: 10733999
• 负责人: Chung Jung Mun
• 金额: $ 66.02万
• 依托单位: ARIZONA STATE UNIVERSITY-TEMPE CAMPUS
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-06-01 至 2028-02-28
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10733999
• 关键词: 6-sulfatoxymelatonin; Acute; Address; Adult; Affect; Anatomy; Anxiety; Caring; Chronic; Chronic Headaches; Chronic low back pain; Circadian Dysregulation; Circadian Rhythms; Clinical; Depressed mood; Development; Dose; Electroencephalography; Evaluation; Evolution; Exhibits; Fibromyalgia; Genes; Genetic Polymorphism; Health Care Costs; High Prevalence; Home; Hour; Incidence; Individual; Intervention; Knowledge; Laboratory Study; Lead; Link; Measures; Mental Depression; Migraine; Nociceptive Stimulus; Orofacial Pain; Pain; Pain Disorder; Pain Research; Participant; Pathway interactions; Patient Self-Report; Phase; Polysomnography; Population; Prevention approach; Prevention strategy; Proxy; Risk; Risk Assessment; Risk Factors; Role; Seminal; Sensory; Severities; Site; Sleep; Sleep Deprivation; Sleep Fragmentations; Sleep disturbances; Temporomandibular Joint Disorders; Testing; Time; Visit; Work; Wrist; actigraphy; body map; burden of illness; catalyst; chronic pain; chronic painful condition; circadian; coping; diaries; disability; effective intervention; follow-up; improved; indexing; insight; member; modifiable risk; monitoring device; multimodality; novel; pain inhibition; pain-related disability; perceived stress; prevent; prospective; psychological distress; recruit; response; shift work; sleep pattern; statistics; treatment strategy; urinary; wireless

PROJECT SUMMARY Chronic pain affects more than one third of the U.S. population, incurring an annual health care cost of $1 trillion. Some of the most prevalent “idiopathic” pain conditions that frequently co-occur, such as chronic low back pain (cLBP), temporomandibular disorders, and fibromyalgia, are referred to as Chronic Overlapping Pain Conditions (COPCs). Among various COPCs, cLBP has the highest prevalence and is one of the top 10 most disabling conditions worldwide. Unfortunately, having multiple COPCs can further interfere with individuals' adaptive pain coping and exacerbate pain-related disability. However, much focus to date has been placed on individual anatomically-based chronic pain conditions and/or one COPC at a time, while little is known about the mechanisms underlying progression to multiple COPCs. A paradigm shift from anatomy-based approaches to mechanism-based approaches recognizing common and modifiable risk factors of multiple COPCs is crucial in developing effective interventions to treat and prevent multiple COPCs. Emerging evidence suggests that sleep and circadian rhythm disturbances—common clinical features across COPCs—that are modifiable, may serve an important role in progression to multiple COPCs via enhancement of pain amplification and psychological distress, which are two critical proximal determinants of multiple COPCs. For the present study, we propose to recruit a total of 300 participants with cLBP (i.e., 200 with cLBP only vs. 100 with cLBP and other COPCs) at baseline. Among these, 200 participants with cLBP only will be followed for 12 months. Sleep and circadian rhythms will be assessed longitudinally (i.e., baseline and 6-month follow-up) using a cutting- edge wireless EEG sleep monitoring device, 24-hour evaluation of the rhythm of urinary 6-sulfatoxymelatonin (aMT6s), wrist worn actigraphy, and daily sleep diaries. Pain amplification (measured by quantitative sensory testing), psychological distress (measured by well-validated self-report measures), and the number of pain sites (measured by a well-validated pain body map) will be assessed at baseline, and 6- and 12-month follow- up visits. The proposed study will (1) comprehensively characterize the severity of sleep and circadian disturbances using ecologically valid multimodal ambulatory assessments among individuals with single and multiple COPCs; (2) prospectively examine whether baseline and changes (0 to 6 months) in sleep and circadian disturbances are associated with changes (0 to 6 months) in pain amplification and psychological distress; and (3) whether pain amplification and psychological distress at 6 months and their changes (6 to 12 months) are related to progression (6 to 12 months) in the number of pain sites (i.e., a valid proxy measure of multiple COPCs), while controlling for the effects of baseline sleep and circadian disturbances. The findings from this proposed work will provide novel insights into potential mechanistic pathways underlying progression to multiple COPCs, which may inform treatment and prevention strategies for these challenging conditions.

项目概要 慢性疼痛影响着超过三分之一的美国人口，每年产生的医疗费用为 1万亿美元。一些最常见的“特发性”疼痛经常同时发生，例如慢性低痛 背痛 (cLBP)、颞下颌疾病和纤维肌痛统称为慢性重叠痛 条件（COPC）。在各种 COPC 中，cLBP 的患病率最高，是最常见的 10 名之一。 全球范围内造成残疾的情况。不幸的是，拥有多个 COPC 会进一步干扰个人的 适应性疼痛应对并加剧与疼痛相关的残疾。然而，迄今为止，人们的大部分注意力都集中在 个体基于解剖学的慢性疼痛状况和/或一次一种 COPC，而对此知之甚少 进展为多种 COPC 的机制。基于解剖学方法的范式转变 采用基于机制的方法，认识多种 COPC 的常见且可改变的风险因素至关重要 制定有效的干预措施来治疗和预防多种 COPC。新出现的证据表明 睡眠和昼夜节律紊乱（COPC 的常见临床特征）是可以改变的，可能 通过增强疼痛放大和作用，在多种 COPC 的进展中发挥重要作用 心理困扰，这是多种 COPC 的两个关键的近端决定因素。对于本研究来说， 我们建议招募总共 300 名患有 cLBP 的参与者（即 200 名仅患有 cLBP 的参与者与 100 名患有 cLBP 和 其他 COPC）处于基线。其中，200 名仅患有 cLBP 的参与者将被跟踪 12 个月。睡觉 昼夜节律将使用切割方法进行纵向评估（即基线和 6 个月的随访） Edge无线脑电睡眠监测仪，24小时评估尿6-磺酰氧基褪黑素节律 (aMT6s)、腕带体动记录仪和每日睡眠日记。疼痛放大（通过定量感觉测量 测试）、心理困扰（通过经过充分验证的自我报告措施来衡量）以及疼痛的次数 将在基线和 6 个月和 12 个月的后续评估中评估部位（通过经过充分验证的疼痛身体图进行测量） 上访。拟议的研究将（1）全面表征睡眠和昼夜节律的严重程度 使用生态上有效的多模式动态评估对单一和单一个体进行干扰 多个 COPC； (2) 前瞻性地检查睡眠和睡眠的基线和变化（0 至 6 个月）是否 昼夜节律紊乱与疼痛放大和心理变化（0至6个月）有关 苦恼； (3) 6个月时是否有疼痛放大和心理困扰及其变化(6至12 月）与疼痛部位数量的进展（6 至 12 个月）相关（即，有效的替代测量 多个 COPC），同时控制基线睡眠和昼夜节律紊乱的影响。研究结果 这项拟议的工作将为研究进展的潜在机制途径提供新的见解 多个 COPC，这可能会为这些具有挑战性的疾病的治疗和预防策略提供参考。