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.

在美国，膝骨关节炎 (OA) 影响着超过 1400 万人。因为没有改变疾病的方法 疗法，治疗的重点是疼痛。 OA 疼痛的多种机制包括伤害感受、 受影响组织对有害刺激的反应，以及中枢和中枢的疼痛敏化和调节 周围神经系统。可以通过定量感官测试来评估敏化和调节 （QST）。最常用的 QST 工具包括： 疼痛压力阈值 - 疼痛敏感度 个人接受标准压力刺激；条件性疼痛调节——抑制性下降的程度 在条件刺激存在的情况下，路径会减弱疼痛的主观体验；和时间 总和——重复应用标准刺激时疼痛敏感性增加的程度。 人们对根据 QST 研究结果开发独特的疼痛敏化表型非常感兴趣， 确定这些表型是否与治疗结果相关。 我们建议在 TeMPO（半月板治疗）中添加疼痛敏化表型的评估 Problems in OA），一项针对患有 OA 的受试者的运动方案的多中心随机对照试验 (RCT) 有症状的半月板撕裂和膝骨关节炎。 TeMPO 将在美国四个中心招募 856 名参与者。科目 在基线和三个月时接受肌肉骨骼评估；我们将添加 QST 测试 肌肉骨骼评估。我们将根据这些开发出独特的疼痛敏化表型 测量和评估疼痛敏化表型、坚持运动和 治疗结果。我们的工作将追求三个目标。 1. 在基线和三个月访视时对 TeMPO 受试者进行 QST。我们将使用 QST 数据 描绘有症状的半月板撕裂的膝关节 OA 患者的独特疼痛敏化表型。 2. 检查疼痛敏化表型是否与更大的疼痛、肌肉无力和 绩效指标得分较差。 3. 确定具有高疼痛敏感表型的受试者是否对运动和运动的依从性较低 运动后疼痛严重程度、力量和表现测试的改善较少。评估是否 较低的运动依从性解释了高痛患者对运动的反应不佳 致敏表型。 该提案中出现的数据将促进我们对敏化作用的机械理解 OA 康复治疗的结果，并将提供有关根据疼痛表型调整治疗的见解。