Neurobiological and Psychological Benefits of Exercise in Chronic Pain and PTSD

运动对慢性疼痛和创伤后应激障碍（PTSD）的神经生物学和心理益处

• 批准号: 9812771
• 负责人: Erica Rose Checko
• 金额: --
• 依托单位: VA BOSTON HEALTH CARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-10-01 至 2020-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9812771
• 关键词: Accounting; Acute; Aerobic; Afghanistan; Allopregnanolone; American; Anaerobic Bacteria; Ants; Area; Award; Biological; Blood Pressure; Body Weight decreased; Boston; Cardiology; Cardiopulmonary; Chronic; Chronic stress; Clinical; Clinical Research; Clinical Trials; Cognitive; Comorbidity; Complex; Conflict (Psychology); Data; Development; Disease; Dropout; Emotional; Exercise; Exercise Physiology; Exercise stress test; Exposure to; Fostering; Foundations; Functional disorder; Funding; Future; Generations; Goals; Grant; Guidelines; Health; Health behavior change; Healthcare; Healthcare Systems; Heart Rate; Home environment; Hormones; Individual; Injury; Intervention; Iraq; Measurable; Measures; Mediating; Mental Depression; Military Personnel; Moderate Exercise; Modification; Monitor; Morbidity - disease rate; Motivation; Neurobiology; Neurohormones; Neuromodulator; Neuropsychology; Pain; Pain Threshold; Participant; Patient Self-Report; Patients; Physiological; Plasma; Population; Post-Traumatic Stress Disorders; Pregnanolone; Prevalence; Problem Solving; Protocols documentation; Psychophysiology; Publishing; Questionnaires; Regimen; Rehabilitation Research; Research; Research Design; Research Support; Role; Running; Scientist; Self Efficacy; Services; Severities; Sex Differences; Strenuous Exercise; Stress; Supervision; Symptoms; Telephone; Testing; Time; Training; Training Programs; Training and Education; Translational Research; Trauma; Traumatic Brain Injury; United States National Institutes of Health; Veterans; Walking; War; Woman; Work; actigraphy; alternative treatment; base; behavior change; chronic pain; chronic pain patient; chronic painful condition; clinically significant; college; comparison group; cost; disability; exercise adherence; exercise physiologist; exercise prescription; exercise program; exercise regimen; exercise training; experience; follow up assessment; health administration; improved; indexing; innovation; intrinsic motivation; mild traumatic brain injury; neuropeptide Y; pain reduction; pain sensitivity; persistent symptom; prevent; programs; psychologic; psychological trauma; public health relevance; recruit; research and development; response; stress related disorder; symptomatology; trauma exposure

DESCRIPTION This study will explicitly compare the effects of a 12-week progressive exercise training program on 1) the clinical symptoms of chronic pain and PTSD, 2) pain threshold and tolerance, and 3) anti-stress, anti- nociceptive neurohormones such as neuropeptide Y (NPY) and allopregnanolone/pregnanolone (ALLO) in veterans with chronic pain/PTSD compared to healthy comparison participants. The revised study design includes a baseline cardiopulmonary exercise assessment (CPX) that will inform the exercise prescription for a 12-week "progressive exercise" training program, comprised of three 30-45 minute exercise sessions per week (walking or running, depending on the ability/capacity of the participant). Exercise sessions will be initially supervised by an exercise physiologist in the Clinical Studies Unit (CSU) at the VA Boston Healthcare System and then each participant will transition into the home. Weekly telephone calls by the PI will provide additional motivational support and assistance with problem solving. Implementation of the prescribed exercise regimen will also be supported by the use of heart rate and actigraph monitors programmed for the participant to achieve their prescribed heart rate range (HRR). Finally, an "endpoint" maximum load exercise assessment will occur at week 13 in order to track measurable change for both psychological and neurobiological factors and to delineate their impact on pain indices and PTSD symptomatology. Both maximum load exercise tests will be performed in accordance with guidelines published by the American College of Cardiology. Measures of pain, pain tolerance (via the cold pressor test) will be implemented 30 minutes before and 30 minutes after exercise testing as well as at a midpoint "check-in" at which self-report questionnaires will also be repeated. Based on the PI's earlier research, the role of exercise motivation and self-efficacy on changes in perceived pain and pain tolerance will be correlated with changes in NPY and ALLO levels, pre and post exercise. It is anticipated that differences in biological responses to aerobic and anaerobic exercise between healthy participants and those with chronic pain/PTSD will predict differences in the psychological and pain-reducing benefits of aerobic and anaerobic exercise. Once identified, such factors could be augmented by modification of the exercise regimen in order to help enhance the ant-stress hormone levels for the pain/PTSD population and experience clinically significant reductions in their symptoms. In order to obtain sufficient power as well as accounting for an expected drop-out rate of 18-20%, the proposed recruitment is 30 participants per condition (total of 60 participants). Data from this pilot work will be used to compute effect sizes in support of a future clinical trial incorporating individually prescribed exercise regimens and a motivationally based exercise behavior change intervention aimed at reducing pain and PTSD symptoms in our Veterans. Advanced education and training is sought by this CDA-2 award applicant in four broad areas: 1) psychophysiology of chronic pain and PTSD with a sub-focus on sex differences, 2) the neurobiology of chronic stress, PTSD, and pain, 3) exercise physiology and 4) the neuropsychology and neurobiology of traumatic brain injury (TBI). The combination of didactic and experiential training in these areas will serve the PI's long-term goal of becoming an independent scientist/practitioner in the VA focused on development of improved treatments for health conditions co-morbid with PTSD such as chronic pain and mild TBI. In the shorter-term, this CDA-2 will allow the PI to develop a more effective, motivationally based, exercise behavior change protocol that fosters long- term exercise compliance in patients with chronic pain/PTSD. This intervention will be used as an adjunct to cognitive interventions for these disorders to be further developed and studied via a larger VA, NIH, or DOD- funded grant for which the PI will apply in years 4-5 of the CDA2.

描述 这项研究将明确比较一个为期12周的渐进式锻炼计划对1）慢性疼痛和PTSD的临床症状，2）疼痛阈值和耐受性，以及3）抗压力，抗伤，抗伤心性神经激素激素，例如神经肽Y（NPY）和Allopreegnanolone/Painanolone/phortanlanolone（allopegnanolone）与Allonolone（allopegnolone hivenanolone）（Veters）与Veters arndanolone（Veters）相比参与者。修订的研究设计包括基线心肺运动评估（CPX），该评估将为练习处方提供12周的“渐进式锻炼”培训计划，该计划包括每周三个30-45分钟的运动课程（根据参与者的能力/能力）组成。锻炼课程最初将由VA波士顿医疗保健系统的临床研究部（CSU）的运动生理学家进行监督，然后每个参与者将过渡到家庭。 PI的每周电话将提供额外的动机支持和解决问题的帮助。通过对参与者进行编程的心率和Actigraph监测器来实现其处方心率范围（HRR）的心率和行动式监测器的使用也将支持规定的运动方案的实施。最后，为了跟踪心理和神经生物学因素的可测量变化，并描述它们对疼痛指数和PTSD症状的影响。两项最大载荷运动测试将根据美国心脏病学院发布的指南进行。疼痛，疼痛耐受性的度量（通过冷压测试）将在运动测试前30分钟和30分钟内以及在中点“签到”后实施，在该中点还将重复自我报告问卷。根据PI的早期研究，运动动机和自我效能感在感知到的疼痛和疼痛耐受性变化上的作用将与NPY和Allo水平，前后运动的变化相关。可以预见，健康参与者与患有慢性疼痛/PTSD的患者对有氧运动和厌氧运动的生物学反应差异将预测有氧和厌氧运动的心理和减轻疼痛益处的差异。一旦确定，就可以通过修改运动方案来增加此类因素，以帮助增强疼痛/PTSD种群的蚂蚁压力激素水平，并在其症状中体验临床上显着降低。为了获得足够的权力以及 预期的辍学率为18-20％，拟议的招聘为30名参与者（总计60名参与者）。该试点工作的数据将用于计算效应大小，以支持未来的临床试验，该试验纳入了单独规定的运动方案 以及基于动机的运动行为改变干预措施，旨在减轻退伍军人的疼痛和PTSD症状。该CDA-2奖申请人在四个广泛领域中寻求高级教育和培训：1）慢性疼痛和PTSD的心理生理学，对性别差异的亚焦点，2）慢性压力，PTSD和疼痛的神经生物学，3）运动生理学和4）神经心理学和神经生物学的神经性心理学和神经性脑损伤（TBI）。在这些领域的教学和体验培训的结合将实现PI的长期目标 成为VA的独立科学家/从业者，重点是开发与PTSD（例如慢性疼痛和轻度TBI）共同发生的健康状况的治疗方法。在短期内，该CDA-2将使PI能够开发出更有效，基于动力的，运动行为改变方案，从而促进慢性疼痛/PTSD患者的长期运动依从性。该干预措施将用作认知干预措施的辅助，以通过较大的VA，NIH或DOD资助的赠款进行进一步开发和研究这些疾病，PI将在CDA2的4 - 5年内适用。