An exercise intervention to Reduce Neuropathic Pain and Brain Inflammation after Spinal Cord Injury

脊髓损伤（SCI）通过脊髓神经导致脑结构和功能的改变 损伤，继发性炎症反应，以及瘫痪生活的后果 和神经性疼痛。由于下半身瘫痪而导致的身体活动不足会迅速导致 肌肉和心脏病的风险。脊髓损伤后死亡的主要原因是 心血管疾病，受伤后一年，那些SCI患者的运动量达到峰值， 能力是普通人的一半。 好消息是，有氧运动可以降低慢性代谢和 心脏呼吸系统疾病，减少炎症和疼痛，并增加情绪和质量 生活运动还可以减少大脑炎症，增强内源性镇痛， 增加了海马体的大小 问题是SCI中的肌肉麻痹限制了达到运动水平的能力 这对于广泛的止痛、抗炎和神经保护益处是必需的。臂 运动可以对心脏和肺的容量有一定的影响，但小肌肉质量， 不足以产生适度的有氧运动。功能性电刺激 (FES)，可以使瘫痪的腿部肌肉收缩，从而允许更多的肌肉运动。 身体要锻炼。完整的划水是由（受刺激的）腿和手臂产生的， 增加活跃的肌肉质量，并导致有氧锻炼，这是足够密集的 来改善心肺功能，也许还有大脑功能 在这项亚急性脊髓损伤受试者的临床试验中，我们将研究12周的FES- RT与12周的等待名单相比，改变了疼痛，大脑结构，内源性阿片类药物 功能和脑部炎症。 我们将使用正电子发射断层扫描和磁共振来测量变化 我们假设疼痛干扰减少，海马体积增加， 增加中脑导水管周围灰质的内源性阿片类物质传递， 海马神经炎症

Spinal Cord Injury (SCI) leads to alterations in brain structure and function by spinal nerve damage, secondary inflammatory responses, and by the consequences of living with paralysis and neuropathic pain. Physical inactivity due to lower body paralysis rapidly leads to loss of muscle, and risk of heart disease. The leading cause of death after a spinal cord injury is cardiovascular disease, and just a year after injury, those with SCI have a peak exercise capacity half that of the unfit general population. The good news is that aerobic exercise reduces the risk of chronic metabolic and cardiorespiratory diseases, reduces inflammation and pain, and increases mood and quality of life. Exercise can also reduce brain inflammation, enhance endogenous analgesia, and increases the size of the hippocampus. The issue is that muscle paralysis in SCI restricts the ability to achieve the levels of exercise that is necessary for broad analgesic, anti-inflammatory and neuroprotective benefits. Arm exercise can have some effects on heart and lung capacity, but the small muscle mass is insufficient to produce more than modest aerobic work. With functional electrical stimulation (FES), leg muscles that are paralyzed can be made to contract, thereby allowing more of the body to be exercised. The full rowing stroke is produced by both the (stimulated) legs and arms, increasing the active muscle mass and resulting in an aerobic work-out that is intensive enough to improve heart, lung, and – maybe – brain function. In this clinical trial of sub-acute spinal cord injured subjects, we will study how 12 weeks of FES- RT, in comparisons to 12 weeks of wait-list, changes pain, brain structure, endogenous opioid function and brain inflammation. We will measure changes using positron emission tomography and magnetic resonance imaging We hypothesize a decrease in pain interference, an increase in hippocampal volume, increased endogenous opioid transmission in the periaqueductal gray, and decreased hippocampus neuroinflammation.