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: 10592728
• 负责人: Christopher D King
• 金额: $ 53.66万
• 依托单位: CINCINNATI CHILDRENS HOSP MED CTR
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-08-01 至 2023-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10592728
• 关键词: Abdominal Pain; Absence of pain sensation; Adolescent; Adult; Age; Awareness; Back; Behavioral; Childhood; Chronic; Clinic; Control Groups; Development; Dimensions; Early identification; Enrollment; Event; Female; Foundations; Future; Gastroenterology; Goals; Individual; Individual Differences; Knowledge; Life; Longevity; Medical center; Methods; Migraine; Musculoskeletal; Musculoskeletal Pain; Neuraxis; Neurosciences; Nociception; Pain; Pain Research; Pain management; Participant; Patients; Pattern; Phenotype; Pilot Projects; Positioning Attribute; Prevention; Public Health; Quality of life; Recording of previous events; Research; Rheumatology; Risk; Risk Factors; Sampling Studies; Sensory; Sleep disturbances; Stimulus; Stress; Testing; Time; United States National Institutes of Health; Youth; base; 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

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 differentiate 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 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 timepoints (3-, 6-, and 12-months). We will also explore whether the disrupted filtering and the transition to COPCs are influenced by factors including concomitant treatments. 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 prevention of progression to COPCs and mitigating long-term risk.

项目摘要 虽然局限性的原发疼痛在年轻人中很普遍，但这些患者中有相当一部分人经历了 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 和残疾进入成年期。促进发展和持续的潜在因素 青年时期的COPC是未知的。目前的提案提供了一种创新的、以前从未探索过的方法 确定在空间(全身同时受到有害刺激)和时间(有害刺激)方面的干扰 随时间呈现的刺激)对伤害性处理的过滤，反映疼痛放大(例如，增加 促进和/或减少抑制)，有助于COPC。几种定量感官测试方法包括 独一无二的定位，用于探测跨空间伤害性过滤中的干扰(空间总和，SS； 条件性疼痛调制(CPM)和时间(时间总和，TS；抵消止痛，OFA)域。 我们最近的试点研究发现，在空间(CPM)和时间(TS)过滤方面有更大中断的证据 有COPC的青年。我们的主要目标是确定伤害性感受的空间和时间过滤 信息区分患有COPC的年轻人和那些有局部疼痛和健康对照的年轻人，并确定 不同类型的受扰伤害性信息处理是否与局部疼痛的转变有关 致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、风湿病和疼痛管理诊所)在大型儿科医疗中心 招募140名患有局部疼痛(偏头痛、腹痛、局部MSK)的青年和140名患有局部疼痛的青年 我们还将招募140名健康青年作为对照组。在最初的表型分析之后 描述伤害性加工的空间和时间维度的干扰(目标1)，参与者将是 每三个月评估一次疼痛状态的变化(局限于COPC)，为期一年(目标2)。在目标1中， 我们假设患有COPC的年轻人将表现出空间紊乱(反映为CPM降低和增强 SS)和时间性(通过增强的TS和减少的OFA)处理与本地化的年轻人相比 疼痛和健康对照。这些发现将描绘出伤害性信息处理的具体中断。 患有COPC的患者。对于目标2，我们假设有一部分患有局部疼痛和精神错乱的年轻人 空间和时间滤波将发展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)。我们还将探讨中断的过滤和 向COPC的转变受到包括伴随治疗在内的因素的影响。我们的研究将提供 首次洞察与COPC及其相关的伤害性过滤中断的存在和影响 局部疼痛的自然主义进展。这些信息对于识别以下风险模式至关重要 有助于防止进展为COPC，并减轻长期风险。