Sleep Disturbance and Pain Sensitivity in Chronic Pain

描述(由申请人提供)：这个职业发展奖(K23)将为候选人提供必要的培训，以建立一个研究计划，以评估慢性疼痛障碍的睡眠障碍的原因、后果和治疗。慢性疼痛是一个主要的健康问题，会导致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和使人丧失能力的特征。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，但针对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，这样疼痛就会干扰睡眠，睡眠中断会增强疼痛的敏感性。这种关系在临床人群中的研究还不充分，缺乏治疗的经验方法。应聘者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)获得多导睡眠监测方面的专业知识；3)为临床试验方法奠定基础。计划在定量感觉测试、定量EEG和临床试验方面提供专家指导。教学课程包括神经科学、生物统计学和临床试验的实施。 该研究计划提出了一项关于与颞下颌关节紊乱病(TMD)相关的慢性肌筋膜痛患者的睡眠的前瞻性研究。这项研究将：1)使用自我报告、活动监测和多导睡眠图来描述TMD患者睡眠障碍的性质，2)评估失眠和/或睡眠微结构异常的诊断是否与压力痛阈值降低有关，3)确定睡眠测量是否可以预测短期(2个月)疼痛严重程度的病程。根据纵向研究的结果和候选人在临床试验方法方面的培训，最终获奖年度将包括进行一项试点临床试验(N=10)，以确定认知-行为干预的可行性，并测试用于治疗慢性疼痛的睡眠障碍的适当安慰剂干预的可信度。候选人的K23研究和培训计划将为将睡眠障碍作为慢性疼痛发展的可改变的风险因素和治疗慢性疼痛的睡眠障碍的干预措施的独立调查提供基础。

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.