Neuroimaging-Based Brain and Spinal Cord Biomarkers for Cervical Radiculopathy

慢性疼痛是一个普遍存在的问题，影响了三分之一的美国人，给医疗保健系统带来了沉重的负担。尽管慢性疼痛普遍存在，但对慢性疼痛的了解仍然很少，目前的临床策略效果甚微。先进的神经影像学技术在慢性疼痛研究中的应用显著增加了我们对大脑在慢性疼痛发展和维持中的作用的理解，通过这些研究，研究人员发现了以前未知的参与疼痛慢性化的神经过程。脊髓是脑干的尾部延伸，积极参与身体和大脑之间神经信号的调制和传输。脊髓中神经处理的改变也被认为在疼痛慢性化中具有不可或缺的作用。脊髓神经影像学的最新进展使得定量研究脊髓在慢性疼痛中的作用成为可能。将基于神经影像学的慢性疼痛研究扩展到脊髓，将为疼痛慢性化的中枢过程提供一个完整的视角。在这个指导性职业发展奖（K23）中，Weber博士将使用颈神经根病作为慢性疼痛的模型条件，识别，表征和纵向跟踪基于神经成像的脑和脊髓慢性疼痛生物标志物。颈椎神经根病是颈部和上肢疼痛的常见原因，并提供了一个独特的机会，科学地研究慢性疼痛的同质患者样本。在目标1和2中，Weber博士将确定右侧颈神经根病所致慢性疼痛患者与年龄和性别匹配的健康对照之间的脑和脊髓网络差异。在目标3中，将在成像后3、6、9和12个月纵向跟踪同一队列的颈神经根病患者的临床指标，并确定有助于颈神经根病疼痛减轻的基于神经成像的预后因素。在同一组患者中，将在12个月时重复成像，并探索大脑和脊髓变化与恢复之间的联系。这项研究将通过进一步阐明慢性疼痛及其恢复的神经过程来推动疼痛领域的发展。在整个获奖期间，Weber博士将获得进行临床研究的新技能和专业知识，包括随机对照试验和将先进的计算方法应用于临床疼痛研究。此外，韦伯博士将获得先进的神经影像学方法，疼痛神经生物学，职业发展和赠款写作的进一步培训。为了完成拟议的研究和培训，韦伯博士组建了一个多学科的世界级导师团队，他们致力于他的成功。这项培训将建立在韦伯博士的临床背景和神经科学博士研究培训的基础上，并最终为他提供知识和技能，以建立一个独立的研究计划，在该计划中，他将领导有影响力的科学研究，交叉神经成像和临床疼痛研究。

Chronic pain is a widespread problem that affects a third of Americans and greatly burdens the health care system. Despite its prevalence, chronic pain remains poorly understood, and the current clinical strategies are minimally effective. The application of advanced neuroimaging techniques to the study of chronic pain has significantly increased our understanding of the brain’s role in the development and maintenance of chronic pain, and through these studies, researchers have uncovered previously unknown neural processes involved in pain chronification. The spinal cord is the caudal extension of the brainstem and is actively involved in the modulation and transmission of neural signals between the body and the brain. Alterations in the neural processing in the spinal cord are also thought to have an integral role in pain chronification. Recent advancements in spinal cord neuroimaging have made the quantitative study of the spinal cord’s role in chronic pain possible. Expanding the neuroimaging-based investigation of chronic pain to the spinal cord will provide a complete perspective of the central processes underlying pain chronification. In this mentored career development award (K23), Dr. Weber will identify, characterize, and longitudinally track neuroimaging-based biomarkers for chronic pain in the brain and spinal cord using cervical radiculopathy as a model condition for chronic pain. Cervical radiculopathy is a common cause of neck and upper limb pain and provides a unique opportunity to scientifically study chronic pain in a homogenous patient sample. In Aims 1 and 2, Dr. Weber will identify differences in the brain and spinal cord networks between patients with chronic pain due to right-sided cervical radiculopathy and age- and sex-matched healthy controls. In Aim 3, clinical measures in the same cohort of cervical radiculopathy patients will be longitudinally tracked at 3, 6, 9, and 12 months after the imaging session, and neuroimaging-based prognostic factors contributing to pain reduction in cervical radiculopathy will be identified. In the same cohort of patients, the imaging will be repeated at 12 months, and the links between the changes in the brain and spinal cord and recovery will be explored. This research will move the pain field forward by further elucidating the neural processes underlying chronic pain and its recovery. Throughout the award period, Dr. Weber will obtain new skills and expertise in conducting clinical studies including randomized controlled trials and applying advanced computational methods to clinical pain research. Additionally, Dr. Weber will gain further training in advanced neuroimaging methods, pain neurobiology, career development, and grant writing. To accomplish the proposed research and training, Dr. Weber has assembled a multi-disciplinary team of world-class mentors who are committed to his success. This training will build on Dr. Weber’s clinical background and doctoral research training in neuroscience and ultimately provide him with the knowledge and skillset to establish an independent research program, in which, he will lead impactful scientific research that intersects neuroimaging and clinical pain research.