Co-design of a gamified, attention-based intervention for chronic pain and chronic dizziness

慢性疼痛影响着近2800万英国成年人（NICE，2021年），并导致其中近800万人中度至重度残疾（Fayaz等人，2016年），这是一个有充分记录和研究的公共卫生问题。慢性头晕的记录或研究较少，但英国一项基于人群的研究发现，在全科医生登记的所有患者中，有4%的人经历过慢性头晕，而且大多数人因症状而丧失行为能力（Nazareth et al, 1999）。从表面上看，慢性疼痛和慢性头晕似乎是完全不同的情况。然而，在这两种情况下，慢性症状都不能很好地用身体组织的损伤或损害来解释。相反，新的研究表明，一种核心的基于大脑的机制是这两种情况的基础：体感过度警觉。体感过度警觉的特点是倾向于对某些身体感觉给予高度关注，并且无法从这些感觉中解脱出来。这可以改变这些感觉信号的处理方式，这意味着无害的感觉输入被大脑误解为表明存在威胁（例如，疼痛，头晕）（Eccleston, 2015）。包括Primary Supervisor在内的三十年对慢性疼痛的研究表明，对疼痛和亚疼痛感觉的体感过度警觉可以维持和加剧慢性疼痛。这已经在行为和大脑层面被观察到。为了支持理论模型（Popkirov et al., 2018），副主管进行的新研究同样表明，体感过度警觉（但对与平衡而不是疼痛相关的感觉）也可能是慢性头晕的基础。发现一种类似的机制支持这两种情况带来了一个令人兴奋的机会：从对慢性疼痛的既定研究中吸取教训，可以迅速推进我们对慢性头晕的理解。同样，对慢性头晕的新兴研究可能会为慢性疼痛带来未知的见解。该项目将利用这一机会，将患有慢性疼痛的成年人和患有慢性头晕的成年人聚集在一起，共同设计一种体感过度警觉的干预措施，旨在改善两种情况下的症状和生活质量。该项目将从学生采访慢性疼痛患者和慢性头晕患者，以及治疗这些疾病的临床医生（医生、心理学家、物理治疗师）开始，以获取关于哪些干预参数对这两种疾病都是相关和可接受的初步反馈。这些发现将为共同设计的躯体感觉过度警觉干预提供信息，该干预将在两个患有慢性疼痛（样本1）或慢性头晕（样本2）的成人样本中进行试点，并使用混合方法进行评估。该项目与一家健康技术初创公司合作，该公司开发了一种游戏化的、基于家庭的体感超警觉性干预的原型，在成人慢性疼痛的试点研究中显示出希望。

Chronic pain, affecting almost 28 million UK adults (NICE,2021) and causing moderate-to-severe disability for almost 8 million of these (Fayaz et al, 2016), is a well-documented and well-studied public health concern. Chronic dizziness is less documented or studied, yet a UK population-based study found that 4% of all patients registered with a general practitioner experience chronic dizziness, and most are incapacitated by their symptoms (Nazareth et al, 1999).On the surface chronic pain and chronic dizziness may appear to be entirely distinct conditions. Yet, in both conditions the chronic symptoms are not well explained by injuries or damage to bodily tissue. Instead, new research indicates that a core brain-based mechanism underlies both conditions: somatosensory hypervigilance.Somatosensory hypervigilance is characterized by the tendency to pay heightened attention towards certain bodily sensations and being unable to disengage from those sensations. This can alter the way that these sensory signals are processed, meaning that innocuous sensory input is misinterpreted by the brain to indicate the presence of a threat (e.g., pain, dizziness) (Eccleston, 2015). Three decades of research on chronic pain, including by the Primary Supervisor, has shown that somatosensory hypervigilance towards painful and sub-painful sensation scan maintain and exacerbate chronic pain. This has been observed behaviorally and at the level of the brain. In support of theoretical models (Popkirov et al., 2018), new research conducted by the Secondary Supervisor similarly suggests that somatosensory hypervigilance (but towards sensations associated with balance rather than pain) may also underpin chronic dizziness. Finding that a similar mechanism underpins both conditions brings an exciting opportunity: drawing from established research on chronic pain could rapidly advance our understanding of chronic dizziness. Likewise, emerging research on chronic dizziness could bring undiscovered insights into chronic pain.The proposed project will leverage this opportunity by bringing together adults with chronic pain and adults with chronic dizziness to co-design a somatosensory hypervigilance intervention, with the aim of improving symptoms and quality of life across both conditions. The project will begin with the student interviewing patients with chronic pain and patients with chronic dizziness, and clinicians treating these conditions (physicians, psychologists, physiotherapists) to capture initial feedback on which intervention parameters are relevant and acceptable for both conditions. These findings will be used to inform a co-designed somatosensory hypervigilance intervention that will be piloted in two samples of adults with chronic pain (sample 1) or chronic dizziness (sample 2)and evaluated using a mixed-method approach. This project is in partnership with a health technology start-up company that has developed a prototype of the gamified, home-based somatosensory hypervigilance intervention that has shown promise in pilot studies of adults with chronic pain.