Pain sensitization in a trial of physical therapy for osteoarthritis and meniscal tear

骨关节炎和半月板撕裂物理治疗试验中的疼痛敏化

• 批准号: 10015200
• 负责人: Jeffrey Neil Katz
• 金额: $ 29.26万
• 依托单位: BRIGHAM AND WOMEN'S HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-09-12 至 2023-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10015200
• 关键词: Address; Adherence; Adult; Affect; Ancillary Study; Clinical; Data; Degenerative polyarthritis; Disease; Enrollment; Ensure; Exercise; Individual; International; Joints; Knee; Knee Osteoarthritis; Lead; Leg; Link; Measures; Meniscus structure of joint; Monitor; Muscle Weakness; Musculoskeletal; Neuraxis; Nociception; Non-Steroidal Anti-Inflammatory Agents; Outcome; Pain; Pain Measurement; Pain Threshold; Participant; Pathway interactions; Patient Self-Report; Patients; Performance; Peripheral; Peripheral Nervous System; Persons; Phenotype; Physical therapy; Prevalence; Randomized Controlled Trials; Rehabilitation Outcome; Replacement Arthroplasty; Reporting; Research; Research Personnel; Role; Schedule; Sensory; Severities; Signal Transduction; Standardization; Stimulus; Symptoms; Testing; Tissues; Treatment Protocols; Treatment outcome; Visit; Walking; Work; authority; balance testing; base; clinically relevant; conditioned pain modulation; conditioning; disability; exercise adherence; exercise program; exercise regimen; experience; functional disability; functional status; health care service utilization; individualized medicine; insight; interest; meter; muscle strength; neurophysiology; pain perception; pain relief; pain sensitivity; patient subsets; performance tests; personalized medicine; pressure; response; success; symptom treatment; tool; treatment response

Knee osteoarthritis (OA) affects over 14 million persons in the US. Because there are no disease modifying therapies, treatment focuses on pain. Several mechanisms underlie pain in OA including nociception, the response to noxious stimuli in affected tissues, and pain sensitization and modulation in the central and peripheral nervous systems. Sensitization and modulation can be assessed with quantitative sensory testing (QST). The most frequently used QST tools include: pain pressure thresholds - the pain sensitivity of individuals to standard pressure stimuli; conditioned pain modulation - the extent that descending inhibitory pathways blunt the subjective experience of pain in the presence of a conditioning stimulus; and temporal summation - the extent that pain sensitivity is increased with repetitive application of a standard stimulus. There is great interest in developing distinct pain sensitization phenotypes based upon QST findings and determining if these phenotypes are associated with treatment outcomes. We propose to add an assessment of pain sensitization phenotypes to TeMPO (Treatment of Meniscal Problems in OA), a multicenter randomized controlled trial (RCT) of exercise regimens for subjects with symptomatic meniscal tear and knee OA. TeMPO will enroll 856 participants across four US centers. Subjects undergo a musculoskeletal assessment at baseline and at three months; we will add QST testing to the musculoskeletal assessment. We will develop distinct pain sensitization phenotypes based upon these measures and assess the associations between pain sensitization phenotypes, adherence to exercise, and treatment outcomes. Our work will pursue three aims. 1. Administer QST in TeMPO subjects at the baseline and three-month visits. We will use QST data to delineate distinct pain sensitization phenotypes in knee OA patients with symptomatic meniscal tears. 2. Examine whether pain sensitization phenotypes are associated with greater pain, muscle weakness and worse scores on performance measures. 3. Determine whether subjects with high pain sensitization phenotypes have lower adherence to exercise and less improvement in pain severity, strength, and performance tests following exercise. Assess whether lower exercise adherence explains suboptimal responses to exercise in persons with high pain sensitization phenotypes. The data emerging from this proposal will advance our mechanistic understanding of the role of sensitization in outcomes of rehabilitative OA treatment and will offer insights about tailoring treatment to pain phenotype.

膝关节骨关节炎（OA）影响美国超过1400万人。因为没有疾病可以改变 治疗的重点是疼痛。OA疼痛的几种机制包括伤害性感受， 对受影响组织中有害刺激的反应，以及中枢和神经系统中的疼痛敏感化和调节 周围神经系统敏化和调制可以通过定量感觉测试来评估 （QST）。最常用的QST工具包括：疼痛压力阈值-疼痛敏感性 个体对标准压力刺激的反应;条件性疼痛调制--下行抑制性疼痛的程度 通路在条件刺激存在下减弱疼痛的主观体验; 总和-疼痛敏感性随着标准刺激的重复应用而增加的程度。 基于QST的发现，人们对开发不同的疼痛致敏表型非常感兴趣， 确定这些表型是否与治疗结果相关。 我们建议在克里思（半月板损伤的治疗）中增加疼痛致敏表型的评估。 OA的问题），一项多中心随机对照试验（RCT）， 症状性膝关节撕裂和膝关节OA。克里思将在美国四个中心招募856名参与者。科目 在基线和三个月时进行肌肉骨骼评估;我们将在 肌肉骨骼评估我们将根据这些结果开发不同的疼痛致敏表型 测量和评估疼痛敏感性表型、坚持锻炼和 治疗结果。我们的工作将追求三个目标。 1.在基线和3个月访视时对克里思受试者进行QST。我们将使用QST数据， 描述了有症状性膝关节撕裂的膝关节OA患者的不同疼痛敏感性表型。 2.检查疼痛敏感性表型是否与更大的疼痛，肌无力和 在绩效指标上得分更低。 3.确定具有高疼痛敏感性表型的受试者是否对运动的依从性较低， 运动后疼痛严重程度、力量和性能测试的改善较少。评估是否 较低的运动坚持性解释了高疼痛患者对运动的次优反应 致敏表型 从这一建议中出现的数据将促进我们对致敏作用的机械理解， 康复OA治疗的结果，并将提供有关定制治疗疼痛表型的见解。