Neuroimaging-Based Brain and Spinal Cord Biomarkers for Cervical Radiculopathy

慢性疼痛是一个普遍存在的问题，影响着三分之一的美国人，给医疗保健系统带来了巨大的负担。尽管它的流行，慢性疼痛仍然知之甚少，目前的临床策略是最低限度的有效。先进的神经成像技术在慢性疼痛研究中的应用大大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与疼痛慢性化有关的神经过程。脊髓是脑干的尾侧延伸，积极参与身体和大脑之间神经信号的调节和传递。脊髓神经处理的改变也被认为在疼痛的慢性化中起着不可或缺的作用。脊髓神经影像学的最新进展使脊髓在慢性疼痛中的作用的定量研究成为可能。将慢性疼痛的神经影像学研究扩展到脊髓，将为疼痛慢性化背后的中枢过程提供一个完整的视角。在这个指导的职业发展奖（K23）中，Weber博士将识别，表征和纵向跟踪基于神经成像的生物标志物，用于脑和脊髓慢性疼痛，并将颈神经根病作为慢性疼痛的模型条件。颈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在一个均匀的患者样本。在目标1和目标2中，Weber博士将确定右侧颈椎神经根病引起的慢性疼痛患者与年龄和性别匹配的健康对照者之间脑和脊髓网络的差异。在Aim 3中，将在影像学检查后3、6、9和12个月对同一队列的颈椎神经根病患者的临床指标进行纵向跟踪，并确定有助于减轻颈椎神经根病疼痛的基于神经影像学的预后因素。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，推动疼痛领域向前发展。在整个奖励期间，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，Weber博士将获得高级神经成像方法、疼痛神经生物学、职业发展和拨款写作方面的进一步培训。为了完成提议的研究和培训，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。该培训将建立在Weber博士在神经科学方面的临床背景和博士研究培训的基础上，并最终为他提供建立独立研究项目的知识和技能，在该项目中，他将领导有影响力的神经影像学和临床疼痛研究交叉的科学研究。

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.