Sleep Disturbance and Pain Sensitivity in Chronic Pain

描述（由申请人提供）：该职业发展奖（K23）将为候选人提供必要的培训，以建立一个研究项目，以评估慢性疼痛障碍中睡眠障碍的原因、后果和治疗方法。慢性疼痛是一个主要的健康问题，会带来巨大的痛苦和经济负担。睡眠障碍是慢性疼痛障碍的一个突出的致残特征。虽然流行病学研究发现，睡眠障碍大大增加了严重的医疗和精神疾病的风险，但关于慢性疼痛的睡眠研究相当有限，质量也很差。对健康受试者的实验研究表明，疼痛和睡眠之间的关系可能是相互的，例如疼痛会干扰睡眠，而睡眠中断会增强疼痛敏感性。这种关系在临床人群中研究不足，缺乏治疗的经验方法。候选人的教育计划包括指导、教学和经验，旨在实现三个职业发展目标：1)获得疼痛评估方面的专业知识，2)获得多导睡眠描记术方面的专业知识，3)为临床试验方法奠定基础。计划对定量感官测试、定量脑电图和临床试验进行专家指导。教学课程包括神经科学、生物统计学和临床试验。

DESCRIPTION (provided by applicant): This Career Development Award (K23) will provide the candidate the necessary training to establish a program of research to evaluate the causes, consequences, and treatments of sleep disturbance in chronic pain disorders. Chronic pain is a major health problem leading to substantial suffering and economic burden. Sleep disturbance is a prominent and disabling feature of chronic pain disorders. While epidemiologic research has found that sleep disturbance substantially increases the risk of serious medical and psychiatric morbidities, sleep research in chronic pain is quite limited and of poor quality. Experimental research in healthy subjects suggests that the relationship between pain and sleep may be reciprocal, such that pain disturbs sleep and sleep disruption enhances pain sensitivity. This relationship has been inadequately studied in clinical populations and empirical approaches to treatment are lacking. The candidate's educational plan includes mentorship, didactics, and experiences designed to achieve 3 career development objectives: 1) Gain expertise in pain assessment, 2) gain expertise in polysomnography and 3) develop a foundation in clinical trials methods. Expert mentorship on quantitative sensory testing, quantitative EEG, and clinical trials is planned. Didactics include courses in neuroscience, biostatistics, and the conduct of clinical trials. The research plan proposes a prospective study of sleep in patients with chronic myofascial pain associated with temporo-mandibular joint disorder (TMD). This study will: 1) Characterize the nature of sleep disturbance in TMD using self-report, activity monitoring, and polysomnography, 2) evaluate whether the diagnosis of insomnia and/or sleep microstructure abnormalities are associated with decreased pressure pain threshold, and 3) determine whether measures of sleep predict the short-term (2-month) course of pain severity. Based on the results of the longitudinal study and the candidate's training in clinical trial methods, the final award year will include conducting a pilot clinical trial (N=10) to establish the feasibility of a cognitive-behavioral intervention and test the credibility of a suitable placebo intervention for treating sleep disturbance in chronic pain. The candidate's K23 research and training plan will provide a foundation for independent investigation of sleep disturbance as a modifiable risk factor for developing chronic pain and interventions to treat sleep disturbance in chronic pain.