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.

项目摘要 慢性疼痛影响超过三分之一的美国人口，每年的医疗保健费用为 1万亿美元一些最普遍的"特发性"疼痛状况，经常同时发生，如慢性低 背痛（cLBP）、颞下颌关节紊乱病和纤维肌痛被称为慢性重叠性疼痛 条件（COPC）。在各种COPC中，cLBP的患病率最高，并且是前10名最常见的COPC之一。 在全球范围内造成残疾。不幸的是，拥有多个COPC可能会进一步干扰个人的健康。 适应性疼痛应对和加剧疼痛相关的残疾。然而，迄今为止， 个体基于解剖学的慢性疼痛病症和/或一次一种COPC，而对 发展为多个COPC的潜在机制。从基于解剖学方法的范式转变 基于机制的方法识别多种COPC的共同和可改变的风险因素至关重要 开发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-是可改变的， 通过增强疼痛放大在向多个COPC进展中发挥重要作用， 心理困扰，这是多个COPC的两个关键的近端决定因素。在本研究中， 我们建议招募共300名患有慢性腰痛的参与者（即，仅cLBP组200例vs cLBP组100例， 其他COPC）。其中，200名仅患有cLBP的参与者将被随访12个月。睡眠 并且将纵向地评估昼夜节律（即，基线和6个月随访）使用切割- 边缘无线脑电睡眠监测装置，24小时尿6-硫酸氧褪黑激素的节律评估 （aMT6）、腕戴式活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（通过有效的自我报告措施测量），以及疼痛的数量 将在基线、6个月和12个月随访时评估部位（通过经过充分验证的疼痛身体图测量）- up访问。拟议的研究将（1）全面表征睡眠和昼夜节律的严重程度 使用生态学有效的多模式动态评估， （2）前瞻性检查基线和睡眠变化（0至6个月）， 昼夜节律紊乱与疼痛放大和心理变化（0至6个月）有关。 6个月时是否存在疼痛放大和心理困扰及其变化（6~12 月）与疼痛部位数量的进展（6至12个月）有关（即，一个有效的代理措施， 多个COPC），同时控制基线睡眠和昼夜节律紊乱的影响。这些发现 这项工作将提供新的见解潜在的机制途径的进展 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信息。