Comparison of the Local Tissue Milieu in Normal muscle and Active and Latent Myo

正常肌肉与活跃和潜在肌肉局部组织环境的比较

• 批准号: 7593133
• 负责人: Jay Shah
• 金额: $ 7.5万
• 依托单位: CLINICAL CENTER
• 依托单位国家: 美国
• 资助国家: 美国
• 起止时间: 至
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/7593133
• 关键词: Acupuncture Points; Anti-Inflammatory Agents; Anti-inflammatory; Area; Biochemical; Budgets; Catecholamines; Characteristics; Class; Clinical; Condition; Data; Enzymes; Evaluation; Exhibits; Functional disorder; Goals; In Situ; Inflammation; Inflammatory; Invasive; Location; Measures; Medial; Mediator of activation protein; Methods; Microdialysis; Muscle; Myofascial Pain Syndromes; Myofascial Trigger Point; Natural History; Neck Pain; Needles; Neuropeptides; Opioid; Outcome Measure; Pain; Palpation; Pathogenesis; Pathology; Patient Self-Report; Patients; Peripheral; Questionnaires; Rheumatism; Sampling; Site; Symptoms; Syndrome; System; Technology; Time; Tissues; Week; base; chronic pain; cytokine; heuristics; improved; muscle metabolism; novel; tool; trapezius muscle

Our recent findings confirm that patients with active myofascial trigger points (MTrPs) have a significantly different biochemical profile (i.e., elevated levels of pro- inflammatory mediators, neuropeptides, cytokines, and catecholamines) within the local milieu of the MTrP compared to those without MTrPs or those with a latent (non-symptomatic) MTrP. These classes of substances are known to be associated with chronic pain states. Furthermore, we found significant differences in analyte levels at needle insertion between the trapezius and unaffected gastrocnemius in the Active group, suggesting that the vicinity of the active MTrP exhibits a unique biochemical milieu of substances associated with pain and inflammation. Additionally, gastrocnemius analyte levels were higher in the Active group than either the Latent or Normal groups. This further suggests that analyte abnormalities may not be limited to local areas of active MTrPs in the upper trapezius but may also be present at sites remote from the active MTrP. It is unclear how the symptoms and physical findings of MTrPs behave over time; they could improve, worsen or remain stable. It is suspected that the symptoms and physical findings of MTrPs will change over time, and these changes will correlate with biochemical analyte levels. The question that we would like to answer in this study is: What is the natural history of MTrPs with respect to pain, local physical findings, and its biochemical milieu (i.e., pro-inflammatory mediators, neuropeptides, cytokines, catecholamines, anti-inflammatory mediators, peripheral opioids and enzymes involved in muscle metabolism.)? We will select three groups of subjects based on the following characteristics 1, 2, and 3 below and follow them for 12 weeks. We will follow all subjects clinically with physical findings and a self-reported questionnaire. Half of the subjects of each group (Normal, Latent and Active) will undergo microdialysis sampling at standardized sites (GB-21 in the upper trapezius muscle and LV-7 in the medial gastrocnemius). The remaining half of the subjects will undergo all of the same evaluations except for microdialysis sampling. A goal of this study is to elucidate the pathophysiology of myofascial trigger points by following the natural history of clinical findings and the local biochemical milieu of the upper trapezius and medial gastrocnemius. Additionally, we would like to investigate whether changes in clinical findings are associated with changes in analyte levels. The acupuncture points GB-21 and LV-7 are selected specifically to standardize the locations of a sampling point in three distinct groups: 1) Normal - healthy subjects without pain and who have no MTrPs identified by palpation bilaterally in GB-21, and who do not have MTrPs identified by palpation bilaterally in LV-7; 2) Latent - healthy subjects without pain in whom latent MTrPs are identified by palpation in GB-21 in one of the upper trapezius muscles, and who do not have MTrPs identified by palpation bilaterally in LV-7; and 3) Active - healthy subjects complaining of neck pain of less than 3 months duration with active MTrPs identified by palpation in GB-21 in one of the upper trapezius muscles, and who do not have MTrPs identified by palpation bilaterally in LV-7.

我们最近的研究结果证实，具有活动性肌筋膜触发点（MTrP）的患者具有显著不同的生化特征（即，促炎介质、神经肽、细胞因子和儿茶酚胺的水平升高）。 已知这些种类的物质与慢性疼痛状态有关。 此外，我们发现活性组中的腓肠肌和未受影响的腓肠肌之间在针插入时的分析物水平存在显著差异，这表明活性MTrP附近表现出与疼痛和炎症相关的物质的独特生物化学环境。此外，活性组的腓肠肌分析物水平高于潜伏组或正常组。这进一步表明，分析物异常可能不限于上肌中的活性MTRP的局部区域，但也可能存在于远离活性MTRP的部位。 目前尚不清楚MTRP的症状和身体表现如何随着时间的推移;它们可能会改善，恶化或保持稳定。 怀疑MTRP的症状和身体检查结果会随着时间的推移而变化，这些变化将与生化分析物水平相关。 我们在这项研究中想要回答的问题是： 关于疼痛、局部身体检查结果及其生化环境（即， 促炎介质、神经肽、细胞因子、儿茶酚胺、抗炎介质、外周阿片类物质和参与肌肉代谢的酶。 我们将根据以下特征1、2和3选择三组受试者，并随访12周。 我们将对所有受试者进行临床随访，包括体格检查结果和自我报告问卷。 每组中一半受试者（正常、潜伏和活动）将在标准化部位（GB-21在上腓肠肌中，LV-7在内侧腓肠肌中）接受微透析采样。 其余一半受试者将接受除微透析采样外的所有相同评价。 本研究的目的是阐明肌筋膜触发点的病理生理学以下的自然历史的临床表现和当地的生化环境的上腓肠肌和内侧腓肠肌。 此外，我们希望研究临床结果的变化是否与分析物水平的变化相关。 穴位GB-21和LV-7是专门选择的，以标准化三个不同组中采样点的位置： 1)正常-健康受试者，无疼痛，触诊未发现MTRP GB-21中双侧，LV-7中双侧触诊未发现MTrP; 2)潜伏性-无疼痛的健康受试者，通过触诊确定潜伏性MTRP 在GB-21中的一个上肌，谁没有MTRP确定 LV-7双侧触诊;和 3)活动-健康受试者主诉颈部疼痛持续时间少于3个月， 在GB-21中通过触诊在一个上腹肌中确定MTrPs， 在LV-7通过双侧触诊确定了MTrPs。