Sensorimotor Function In Pathological Pain

有大量的证据表明，一些慢性疼痛的条件涉及到皮质运动系统的变化。大多数关于慢性疼痛运动系统的见解都涉及初级运动皮层（M1）。例如，非侵入性脑刺激揭示了与慢性肢体或背部疼痛患者受影响身体部位连接的M1部分的变化。然而，针对慢性肢体疼痛的M1治疗需要高强度的训练，只有少数患者受益。患有慢性疼痛的人不仅在运动方面有困难，而且需要更长的时间才能在精神上旋转并识别与他们受影响的肢体相对应的图片，这表明他们在表现（而不仅仅是执行）运动方面存在问题。因此，我怀疑“高阶”运动区域也发生了变化，这些区域用于规划和解释运动。我的项目将使用行为，神经心理学测试和非侵入性脑刺激方法，以更深入地了解皮质运动对慢性疼痛的贡献，以发现潜在的新治疗目标。我将进行四项研究：1）二级数据的网络分析，以确定关键目标慢性疼痛症状以及这些症状之间的关系。2)一项关于多种慢性疼痛状况与无痛对照的动作感知和理解的大规模在线研究，其特定目标是将更广泛的异质人群作为参与者。这将包括使用神经心理学测试来提供对高阶运动功能内的可能变化的见解，以及这些变化如何随条件而变化，以及疼痛位置，严重程度和持续时间。3）一项关于高阶运动功能和运动的更具体的基于实验室的研究，将无疼痛控制与复杂区域疼痛综合征患者进行比较，复杂区域疼痛综合征是一种与运动困难相关的特定疼痛状况。4)一项基于实验室的研究，使用非侵入性脑刺激（经颅磁刺激）来研究复杂区域疼痛综合征患者的M1和高阶运动区之间的皮质相互作用。这些研究将共同提高对慢性疼痛状况的理解，并找到潜在的新治疗靶点。慢性疼痛是一个巨大的人类健康问题，在不同的国家有所不同，影响8%至55.2%的人口，也使用相当多的医疗资源。因此，寻找新的疗法对研究理事会来说是重要的和相关的。

There is substantial evidence that some chronic pain conditions involve changes to the cortical motor system. Most insights about the motor system in chronic pain concern the primary motor cortex (M1). For example, non-invasive brain stimulation has revealed changes in the parts of M1 connecting to affected body parts in people with chronic limb or back pain. However, treatments targeting M1 for chronic limb pain require intense training, and only a few patients benefit. People with chronic pain not only have difficulties with movements but also take longer to mentally rotate and identify pictures corresponding to their affected limb, suggesting problems with representing (not just executing) movements. Consequently, I suspect there are also changes to 'higher order' motor areas, those used for planning and interpreting movements. My project will use behavioural, neuropsychological tests and non-invasive brain stimulation methods to provide a more in-depth understanding of cortical motor contributions to chronic pain, to discover potential new targets for treatment. I will conduct four studies:1) A network analysis of secondary data to identify key target chronic pain symptoms and how those relate to one another. 2) A large-scale, online study of action perception and comprehension in multiple chronic pain conditions versus pain-free controls with the specific goal to reach a wider, heterogeneous population as participants. This will include using neuropsychological tests to provide insights into possible changes within higher-order motor functions and how these vary by condition, and by pain location, severity, and duration.3) A more specific lab-based study on higher-order motor functions and movements comparing pain free controls to patients with Complex Regional Pain Syndrome, a specific pain condition associated with movement difficulties. 4) A lab-based study using non-invasive brain stimulation (Transcranial Magnetic Stimulation) to investigate the cortical interaction between M1 and a higher-order motor area in patients with Complex Regional Pain Syndrome.The studies together will improve understanding of chronic pain conditions and find potential new targets for treatment. Chronic pain is a large human health problem that varies in different countries affecting 8% to 55.2% of the population also using considerable healthcare resources. Finding new therapies is therefore important and relevant to the research council.