Neurobiological and Psychological Benefits of Exercise in Chronic Pain and PTSD

运动对慢性疼痛和创伤后应激障碍（PTSD）的神经生物学和心理益处

• 批准号: 9000715
• 负责人: Erica Rose Checko
• 金额: --
• 依托单位: VA BOSTON HEALTH CARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-10-01 至 2018-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9000715
• 关键词: Accounting; Acute; Aerobic; Afghanistan; Allopregnanolone; American; Ants; Area; Award; Biological; Blood Pressure; Body Weight decreased; Boston; Cardiology; Cardiopulmonary; Chronic; Chronic stress; Clinical; Clinical Research; Clinical Trials; Cognitive; Complex; Conflict (Psychology); Data; Development; Disease; Drops; Emotional; Exercise; Exercise Physiology; Exercise stress test; Exposure to; Fostering; Foundations; Functional disorder; Funding; Future; Generations; Goals; Grant; Guidelines; Health; Health behavior change; Healthcare; Healthcare Systems; Heart Rate; Home environment; Hormones; Individual; Injury; Intervention; Iraq; Measurable; Measures; Mediating; Mental Depression; Military Personnel; Modification; Monitor; Morbidity - disease rate; Motivation; Neurobiology; Neurohormones; Neuromodulator; Neuropsychology; Nociception; Pain; Pain Threshold; Participant; Patient Self-Report; Patients; Physiological; Plasma; Population; Post-Traumatic Stress Disorders; Pregnanolone; Prevalence; Problem Solving; Protocols documentation; Psychophysiology; Publishing; Questionnaires; Regimen; Rehabilitation Research; Research; Research Design; Research Support; Role; Running; Scientist; Self Efficacy; Services; Severities; Sex Characteristics; Stress; Symptoms; Telephone; Testing; Time; Training; Training and Education; Translational Research; Trauma; Traumatic Brain Injury; United States National Institutes of Health; Veterans; Walking; War; Woman; Work; alternative treatment; base; behavior change; chronic pain; clinically significant; college; comparison group; cost; disability; exercise adherence; exercise physiologist; exercise prescription; exercise program; exercise regimen; exercise training; experience; follow-up; health administration; improved; indexing; innovation; intrinsic motivation; mild traumatic brain injury; neuropeptide Y; prevent; programs; psychologic; psychological trauma; public health relevance; research and development; response; symptomatology

DESCRIPTION This study will explicitly compare the effects of a 12-week progressive exercise training program on 1) the clinical symptoms of chronic pain and PTSD, 2) pain threshold and tolerance, and 3) anti-stress, anti- nociceptive neurohormones such as neuropeptide Y (NPY) and allopregnanolone/pregnanolone (ALLO) in veterans with chronic pain/PTSD compared to healthy comparison participants. The revised study design includes a baseline cardiopulmonary exercise assessment (CPX) that will inform the exercise prescription for a 12-week "progressive exercise" training program, comprised of three 30-45 minute exercise sessions per week (walking or running, depending on the ability/capacity of the participant). Exercise sessions will be initially supervised by an exercise physiologist in the Clinical Studies Unit (CSU) at the VA Boston Healthcare System and then each participant will transition into the home. Weekly telephone calls by the PI will provide additional motivational support and assistance with problem solving. Implementation of the prescribed exercise regimen will also be supported by the use of heart rate and actigraph monitors programmed for the participant to achieve their prescribed heart rate range (HRR). Finally, an "endpoint" maximum load exercise assessment will occur at week 13 in order to track measurable change for both psychological and neurobiological factors and to delineate their impact on pain indices and PTSD symptomatology. Both maximum load exercise tests will be performed in accordance with guidelines published by the American College of Cardiology. Measures of pain, pain tolerance (via the cold pressor test) will be implemented 30 minutes before and 30 minutes after exercise testing as well as at a midpoint "check-in" at which self-report questionnaires will also be repeated. Based on the PI's earlier research, the role of exercise motivation and self-efficacy on changes in perceived pain and pain tolerance will be correlated with changes in NPY and ALLO levels, pre and post exercise. It is anticipated that differences in biological responses to aerobic and anaerobic exercise between healthy participants and those with chronic pain/PTSD will predict differences in the psychological and pain-reducing benefits of aerobic and anaerobic exercise. Once identified, such factors could be augmented by modification of the exercise regimen in order to help enhance the ant-stress hormone levels for the pain/PTSD population and experience clinically significant reductions in their symptoms. In order to obtain sufficient power as well as accounting for an expected drop-out rate of 18-20%, the proposed recruitment is 30 participants per condition (total of 60 participants). Data from this pilot work will be used to compute effect sizes in support of a future clinical trial incorporating individually prescribed exercise regimens and a motivationally based exercise behavior change intervention aimed at reducing pain and PTSD symptoms in our Veterans. Advanced education and training is sought by this CDA-2 award applicant in four broad areas: 1) psychophysiology of chronic pain and PTSD with a sub-focus on sex differences, 2) the neurobiology of chronic stress, PTSD, and pain, 3) exercise physiology and 4) the neuropsychology and neurobiology of traumatic brain injury (TBI). The combination of didactic and experiential training in these areas will serve the PI's long-term goal of becoming an independent scientist/practitioner in the VA focused on development of improved treatments for health conditions co-morbid with PTSD such as chronic pain and mild TBI. In the shorter-term, this CDA-2 will allow the PI to develop a more effective, motivationally based, exercise behavior change protocol that fosters long- term exercise compliance in patients with chronic pain/PTSD. This intervention will be used as an adjunct to cognitive interventions for these disorders to be further developed and studied via a larger VA, NIH, or DOD- funded grant for which the PI will apply in years 4-5 of the CDA2.

描述 本研究将明确比较12周渐进式运动训练计划对患有慢性疼痛/PTSD的退伍军人与健康对照参与者中的1）慢性疼痛和PTSD的临床症状，2）疼痛阈值和耐受性，以及3）抗应激、抗伤害感受神经激素如神经肽Y（NPY）和别孕烯醇酮/孕烯醇酮（ALLO）的影响。修订后的研究设计包括基线心肺运动评估（CPX），该评估将为为期12周的“渐进式运动”训练计划提供运动处方，包括每周3次30-45分钟的运动课程（步行或跑步，取决于参与者的能力/能力）。运动课程最初将由VA波士顿医疗保健系统临床研究单位（CSU）的运动生理学家监督，然后每位参与者将过渡到家中。PI每周电话将提供额外的激励支持和帮助解决问题。还将通过使用心率和活动记录仪监测器（为受试者编程）来支持处方运动方案的实施，以达到其处方心率范围（HRR）。最后，将在第13周进行“终点”最大负荷运动评估，以跟踪心理和神经生物学因素的可测量变化，并描述其对疼痛指数和PTSD病理学的影响。两项最大负荷运动试验均将根据美国心脏病学会发布的指南进行。将在运动试验前30分钟和运动试验后30分钟以及在中点“登记”时测量疼痛、疼痛耐受性（通过冷加压试验），在中点“登记”时也将重复自我报告问卷。根据PI的早期研究，运动动机和自我效能对感知疼痛和疼痛耐受性变化的作用将与运动前后NPY和ALLO水平的变化相关。预计健康参与者和慢性疼痛/PTSD患者对有氧和无氧运动的生物反应差异将预测有氧和无氧运动的心理和减轻疼痛益处的差异。一旦确定，这些因素可以通过修改运动方案来增强，以帮助提高疼痛/PTSD人群的抗应激激素水平，并在临床上显着减少他们的症状。为了获得足够的能量， 考虑到预计辍学率为18- 20%，建议每种条件招募30名参与者（共60名参与者）。这项试点工作的数据将用于计算效应量，以支持未来的临床试验，包括个人处方的运动方案 以及一种基于动机的运动行为改变干预，旨在减少我们退伍军人的疼痛和创伤后应激障碍症状。该CDA-2奖申请人在四个广泛领域寻求高级教育和培训：1）慢性疼痛和创伤后应激障碍的心理生理学，重点关注性别差异，2）慢性应激，创伤后应激障碍和疼痛的神经生物学，3）运动生理学和4）创伤性脑损伤（TBI）的神经心理学和神经生物学。在这些领域的教学和经验培训相结合将服务于PI的长期目标 成为一名独立的科学家/医生在弗吉尼亚州专注于发展改善治疗健康状况共病与创伤后应激障碍，如慢性疼痛和轻度创伤性脑损伤。在短期内，该CDA-2将允许PI开发更有效的、基于动机的运动行为改变方案，以促进慢性疼痛/PTSD患者的长期运动依从性。该干预将作为认知干预的辅助手段，用于这些疾病的进一步开发和研究，通过更大的VA、NIH或DOD资助的补助金进行，PI将在CDA的第4-5年申请2。