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Intrathecal Baclofen and Pain Outcomes in Cerebral Palsy

鞘内注射巴氯芬与脑瘫的疼痛结果

基本信息

批准号：
9244672
负责人：
FRANK J SYMONS
金额：
$ 48.48万
依托单位：
UNIVERSITY OF MINNESOTA
依托单位国家：
美国
项目类别：
财政年份：
2013
资助国家：
美国
起止时间：
2013-04-01 至 2020-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9244672
关键词：
Activities of Daily Living Address Analgesics Baclofen Belief Biological Biological Markers Caregivers Catheters Cerebral Palsy Cerebrospinal Fluid Characteristics Child Chronic Chronic disabling pain Clinical Cognitive Congenital musculoskeletal anomalies Data Decision Making Distress Dose Equilibrium Failure Family Family member Frequencies Goals Health Personnel Immune Impairment Implant Individual Differences Inflammation Inflammatory Knowledge Measurement Measures Modeling Motor Muscle Contraction Muscle Spasticity Muscular Dystrophies Musculoskeletal Neurodevelopmental Disability Neurodevelopmental Disorder Neurosecretory Systems Nociception Operative Surgical Procedures Oral Outcome Pain Pain Nature Pain Research Pain management Patient Selection Patients Physiological Physiology Population Procedures Process Prospective Studies Proxy Psychosocial Factor Public Health Pump Quality of life Reporting Research Rett Syndrome Risk Sampling Schedule Scientific Advances and Accomplishments Selection Criteria Seroma Severities Spastic Stress Structure Subgroup Syndrome System Testing Treatment outcome Vulnerable Populations Withdrawal Work Wound Infection chronic pain clinical decision-making clinically relevant design disability experience functional outcomes improved innovation insight novel outcome prediction primary outcome prospective prospective test psychosocial public health relevance response spasticity treatment effect treatment response

项目摘要

DESCRIPTION (provided by applicant): This application addresses PA 10-006 Mechanisms, Models, Measurement, and Management in Pain Research (R01). The majority of children with cerebral palsy (CP) live with spasticity and spasticity-induced disabling chronic pain. One of the front-line treatments for spasticity involves surgically implanting a pump to intrathecally deliver baclofen (ITB). Doing so avoids the problems with orally administered baclofen but creates problems of its own including general surgical risks but also procedure specific issues such as cerebral spinal fluid (CSF) leaks and catheter malfunction leading to serious withdrawal complications. Thus, the procedure is not without risk, but on balance the evidence is tilted toward efficacy for spasticity outcomes by reducing spasticity. It is less clear, however, whether the chronic pain is also and always reduced. There are mixed and muddled results specific to pain outcomes; mixed because in some studies pain is reported to decrease but in others there is no apparent change, muddled because the majority of the studies are poorly designed with pain poorly measured and so the results are scientifically uncertain and clinically ambiguous. This specific problem - whether or not pain improves following ITB treatment - is part of a much broader general issue - whether we can use scientific advances from pain research to improve our clinical understanding of pain and disability among children with significant intellectual, motor, and communicative impairments associated with neurodevelopmental disorders. The overall goal of this application is to initiate a line of research with the primary objective of improving our scientific understanding of changes in chronic pain in response to treatment among children with significant neurodevelopmental disabilities. The specific purpose of this interdisciplinary translational proposal is to clarify the clinical ambiguity in pain outcomes in relation to ITB treatment by prospectively studying a sample of children with CP and spasticity before and after ITB implant. By doing so, we will be able to (a) examine in detail the relation between changes in spasticity and pain, (b) evaluate whether pain that persists even in the presence of reduced spasticity will be associated with poorer functional outcomes, and (c) empirically test whether treatment parameters associated with the pump implant, clinical features associated with CP, or physiological variables associated with pain, stress, and inflammation interact to influence pain specific treatment outcomes. To date, there has been no comprehensive study specific to chronic pain among children with CP treated with ITB pump implants. Considering the vulnerable clinical population for the proposed project, we believe there is an urgent imperative to try to make scientific advances from the 'bench' relevant to real-world pain and disability problems. Ultimately, the knowledge gain should transfer into a clinical decision making aide with respect to improving patient selection criteria and by informing patients, their families, and healthcare providers more completely about the full range of expected outcomes with respect to pain and function.

描述（由申请人提供）：本申请涉及PA 10-006疼痛研究中的机制、模型、测量和管理（R01）。大多数脑瘫（CP）患儿伴有痉挛和痉挛引起的致残性慢性疼痛。痉挛的一线治疗方法之一是通过手术植入一个泵来进行鞘内输送

项目成果

期刊论文数量（13）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

Psychometric properties of the brief pain inventory modified for proxy report of pain interference in children with cerebral palsy with and without cognitive impairment.

DOI：
10.1097/pr9.0000000000000666
发表时间：
2018-07
期刊：
Pain reports
影响因子：
4.8
作者：
Barney CC;Stibb SM;Merbler AM;Summers RLS;Deshpande S;Krach LE;Symons FJ
通讯作者：
Symons FJ

Can biomarkers differentiate pain and no pain subgroups of nonverbal children with cerebral palsy? A preliminary investigation based on noninvasive saliva sampling.

生物标志物可以区分脑瘫非语言儿童的疼痛和无痛亚组吗？

DOI：
10.1111/pme.12545
发表时间：
2015
期刊：
Pain medicine (Malden, Mass.)
影响因子：
0
作者：
Symons,FrankJ;ElGhazi,Issam;Reilly,BrianG;Barney,ChantelC;Hanson,Leah;Panoskaltsis-Mortari,Angela;Armitage,IanM;Wilcox,GeorgeL
通讯作者：
Wilcox,GeorgeL

Modifying quantitative sensory testing to investigate behavioral reactivity in a pediatric global developmental delay sample: Relation to peripheral innervation and chronic pain outcomes.