Examining the Role of Central Sensitization with Aging: an Investigation of Older Adults with and without Chronic Low Back Pain

项目概要/摘要 在美国，慢性疼痛每年影响超过500万老年人。预计这一负担将 在未来几年中，由于总人口正在老龄化，慢性疼痛的患病率将异常增加， 在老年人中高，并且不知道为什么衰老是慢性疼痛疾病的风险因素。国家 老龄问题研究所敏锐地意识到这一僵局， “阐明疼痛体验的机制及其在衰老中的后果”。文学 确定中枢神经系统的致敏（称为中枢致敏）是一种损害， 放大了患有慢性疼痛的年轻和中年成人的疼痛感知，导致疼痛持续性， 导致残疾。然而，很少有研究评估了中枢神经系统的存在和后果。 在老年慢性疼痛病症中的致敏作用，包括慢性腰痛。这种知识差距是 由于缺乏对中枢敏感化是否随年龄增长而发生的理解， 中枢致敏的明确诊断标准因此，本提案的目标是阐明， 以及作为生物老化的结果，中枢致敏是如何发展的，并描述了 慢性腰痛老年人中枢敏感化的临床意义在目标1中，我们 确定患有慢性腰痛的老年人表现出增加的静态和 动态疼痛敏感性与无慢性疼痛的老年人和年轻人相比。目标2：量化 这三组之间实验诱导的致敏性的差异。在目标3中，我们将研究 中枢致敏指标与疼痛、身体功能和 老年慢性腰痛患者的自觉残疾。这一提议的核心假设是 患有慢性腰痛的老年人将表现出最大程度的中枢敏感化， 这将与更大的临床疼痛强度、更差的身体功能和更差的感知有关。 残疾。研究结果有可能为初级、二级和三级预防工作提供信息， 确定CS是否随生物老化而发生， 新的测量方法，并为潜在的可修改的 分别给老年人带来慢性腰痛负担的机制。这项建议是一个关键的第一次 这是朝着这个奖学金申请人的长期目标迈出的一步，即改善小学、中学和大学的教育水平。 通过量化和干预机制为弱势慢性疼痛人群进行预防工作 (such作为CS），其是适应不良的疼痛敏感性的基础。此外，该研究金提案将提供 申请人接受过老年学、疼痛科学和康复专业导师的结构化培训; 这项培训不仅有助于完成这项研究项目，而且还为申请人做好准备， 作为一名富有成效的临床科学家。

PROJECT SUMMARY/ABSTRACT Chronic pain affects over 5 million older adults every year in the United States. This burden is expected to worsen in the coming years given that the general population is aging, chronic pain prevalence is inordinately high among older adults, and it is unknown why aging is a risk factor for chronic pain disorders. The National Institute on Aging is keenly aware of this impasse, as evidenced by requests for research to focus on the “elucidation of mechanisms underlying pain experience and its consequences in aging”. Literature has established sensitization of the central nervous system (termed central sensitization) as an impairment that amplifies pain perception in young and middle aged adults with chronic pain, leading to pain persistence and resultant disability. However, a paucity of research has evaluated the presence and consequences of central sensitization in geriatric chronic pain conditions, including chronic low back pain. This gap in knowledge is further complicated by a lack of understanding whether central sensitization occurs with aging, and an absence of definitive diagnostic criteria for central sensitization. Therefore, the goals of this proposal are to elucidate if and how central sensitization develops as a result of biological aging, and characterize the presence and clinical implications of central sensitization in older adults with chronic low back pain. In Aim 1, we will determine the extent to which older adults with chronic low back pain demonstrate increased static and dynamic pain sensitivity compared to older and younger adults without chronic pain. For Aim 2, we will quantify differences in experimentally-induced sensitization between these three groups. In Aim 3, we will examine the relationship between indicators of central sensitization and clinical measures of pain, physical function and perceived disability among older adults with chronic low back pain. The central hypothesis of this proposal is that older adults with chronic low back pain will demonstrate the greatest magnitude of central sensitization, which will be associated with greater clinical pain intensity, poorer physical function, and worse perceived disability. The results have the potential to inform primary, secondary and tertiary prevention efforts by determining if CS occurs with biological aging, optimizing the identification of CS by combining standard and novel measurement methodologies, and providing foundational evidence for a potentially modifiable mechanism that burdens older adults with chronic low back pain, respectively. This proposal is a critical first step towards the long-term goal of this fellowship applicant, which is to improve primary, secondary and tertiary prevention efforts for vulnerable chronic pain populations by quantifying and intervening upon mechanisms (such as CS) that underlie maladaptive pain sensitivity. Additionally, this fellowship proposal will provide the applicant with structured training from mentors with expertise in gerontology, pain science and rehabilitation; this training will not only facilitate completion of this research project, but also prepare the applicant for a career as a productive clinician scientist.