Disrupted Spatial and Temporal Nociceptive Filtering in Adolescents with and Risk for Overlapping Pain Conditions

患有重叠疼痛的青少年的空间和时间伤害性过滤被破坏以及存在重叠疼痛的风险

• 批准号: 10582930
• 负责人: Christopher D King
• 金额: $ 65.57万
• 依托单位: CINCINNATI CHILDRENS HOSP MED CTR
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-08-15 至 2027-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10582930
• 关键词: Abdominal Pain; Absence of pain sensation; Adolescent; Adult; Age; Awareness; Back; Behavioral; Central Nervous System; Childhood; Chronic; Clinic; Control Groups; Development; Dimensions; Early identification; Enrollment; Female; Foundations; Future; Gastroenterology; Goals; Individual; Individual Differences; Intensive Care; Knowledge; Longevity; Medical center; Methods; Migraine; Musculoskeletal; Musculoskeletal Pain; National Institute of Neurological Disorders and Stroke; Neurosciences; Nociception; Pain; Pain Research; Pain management; Participant; Patients; Pattern; Pharmaceutical Preparations; Phenotype; Pilot Projects; Positioning Attribute; Prevention; Public Health; Quality of life; Research; Rheumatology; Risk; Risk Factors; Sampling Studies; Sensory; Sleep; Stimulus; Stress; Testing; Time; United States National Institutes of Health; Youth; biopsychosocial; chronic pain; chronic painful condition; clinical infrastructure; clinically relevant; conditioned pain modulation; daily functioning; design; disability; experience; high risk; innovation; insight; longitudinal design; multidisciplinary; patient subsets; prevent; programs; prospective; psychosocial; recruit; screening; sex; somatosensory; stability testing; traumatic event

PROJECT ABSTRACT While localized primary pain conditions are prevalent in youth, a significant subset of these patients experience multiple pain conditions and meet the criteria for chronic overlapping pain conditions (COPCs). COPCs have a marked negative impact on daily functioning and quality of life in youth and carry a high risk for continued pain and disability into adulthood. The underlying factors contributing to the development and persistence of COPCs in youth are unknown. The current proposal offers an innovative and previously unexplored approach to determine whether disruptions in spatial (concurrent noxious stimuli across the body) and temporal (noxious stimuli presented over time) filtering of nociceptive processing, reflecting pain amplification (e.g., increased facilitation and/or reduced inhibition), contribute to COPCs. Several quantitative sensory testing methods are uniquely positioned to probe disruptions in nociceptive filtering across spatial (spatial summation, SS; conditioned pain modulation, CPM) and temporal (temporal summation, TS; offset analgesia, OFA) domains. Our recent pilot studies found evidence for greater disruptions in spatial (CPM) and temporal (TS) filtering in youth with COPCs. Our primary objective is to determine if spatial and temporal filtering of nociceptive information differentiates youth with COPCs from those with localized pain and healthy controls and determine whether distinct profiles of disrupted nociceptive processing are associated with the transition of localized pain to COPCs. To accomplish this, the current study will leverage expertise and a vast clinical infrastructure (Migraine, Gastroenterology, Rheumatology and Pain Management clinics) at a large pediatric medical center to enroll 140 youth with a localized pain condition (migraine, abdominal pain, local MSK), and 140 youth with COPC’s. We will also recruit 140 healthy youth to serve as a control group. Following initial phenotyping to delineate disruptions in spatial and temporal dimensions of nociceptive processing (Aim 1), participants will be assessed for changes in pain status (localized to COPCs) every three months for one year (Aim 2). In Aim 1, we hypothesize that youth with COPCs will show disrupted spatial (reflected by reduced CPM and enhanced SS) and temporal (reflected by enhanced TS and reduced OFA) processing compared to youth with localized pain and healthy controls. These findings will delineate specific disruptions of nociceptive processing in patients with COPCs. For Aim 2, we hypothesize that a subset of youth with localized pain and disrupted spatial and temporal filtering will develop COPCs. We will examine the stability of spatial and temporal filtering at clinically relevant time points (3-, 6-, and 12-months). We will also explore whether other factors, including concomitant treatments, influence the disrupted filtering and the transition to COPCs. Our research will provide the first insight into the presence and impact of disrupted nociceptive filtering related to COPCs and its naturalistic progression from localized pain. This information will be critical in identifying risk patterns that can be useful in the prevention of progression to COPCs and mitigating long-term risk.

项目摘要 虽然局部原发性疼痛状况在年轻人中普遍存在，但这些患者中的一个重要子集经历了 多种疼痛状况，并符合慢性重叠疼痛状况（COPC）的标准。COPC有一个 对青少年的日常功能和生活质量有明显的负面影响，并具有持续疼痛的高风险 和残疾进入成年。促进发展和持续的基本因素 年轻人的COPC是未知的。目前的建议提供了一个创新的和以前没有探索过的方法 以确定是否在空间（全身并发的有害刺激）和时间（有害刺激） 随时间呈现的刺激）对伤害感受处理的过滤，反映疼痛放大（例如，增加 促进和/或减少的抑制），有助于COPC。几种定量感官测试方法是 独特地定位以探测跨空间（空间总和，SS; 条件性疼痛调制（CPM）和时间域（时间总和（TS）;补偿镇痛（OFA））。 我们最近的试点研究发现了空间（CPM）和时间（TS）过滤更大中断的证据， 青少年COPC我们的主要目的是确定是否空间和时间过滤的伤害性 信息区分青年COPC与那些与局部疼痛和健康的控制，并确定 不同的伤害性感受过程的中断是否与局部疼痛的转变有关 到COPC。为了实现这一目标，目前的研究将利用专业知识和庞大的临床基础设施 （偏头痛、胃肠病学、流变学和疼痛管理诊所） 招募140名患有局部疼痛状况（偏头痛，腹痛，局部MSK）的青年，以及140名患有 COPC的。我们还将招募140名健康青少年作为对照组。在初始表型分析后， 描述伤害性处理的空间和时间维度的中断（目标1），参与者将 每三个月评估疼痛状态的变化（局限于COPC），持续一年（目标2）。在目标1中， 我们假设患有COPC的青少年将表现出空间中断（反映在CPM减少和增强 SS）和时间（通过增强TS和减少OFA反映）处理与青年相比， 疼痛和健康对照。这些发现将描述特定的伤害性处理中断， COPC患者对于目标2，我们假设一个子集的青年与局部疼痛和中断， 空间和时间滤波将开发COPC。我们将检查空间和时间滤波的稳定性 在临床相关时间点（3个月、6个月和12个月）。我们还将探讨其他因素，包括 伴随治疗，影响破坏的过滤和向COPC的过渡。我们的研究将提供 第一次深入了解与COPC及其相关的伤害性过滤中断的存在和影响， 局部疼痛的自然发展这些信息对于确定风险模式至关重要， 有助于预防进展为COPC和减轻长期风险。