Research Training Using TMS to Study Pain Processing in Long-Term Opioid Use

描述（由申请人提供）：此申请是为了获得指导职业发展奖（K23），以支持凯文·约翰逊博士在以患者为导向的研究方面的研究和培训，这些研究与理解慢性疼痛、成瘾及其交叉的核心机制有关。慢性疼痛对社会和个人都有巨大的影响。长期使用阿片类药物治疗慢性疼痛可能缺乏疗效，甚至引起痛觉过敏。美沙酮维持是药物滥用的一种治疗方法，但长期使用美沙酮对疼痛系统的影响尚不清楚。约翰逊博士在生物医学工程、心理学、神经科学、护理和以患者为导向的神经科学研究方面拥有独特的教育背景。他将接受进一步的研究培训，专门关注慢性腰痛（CLBP）患者和药物滥用美沙酮维持治疗的患者。第一个主要研究目的是表征长期使用阿片类药物对疼痛加工的影响，采用以下参与者组：(1)健康对照组；(2)不使用阿片类药物的CLBP对照患者；(3)长期使用阿片类药物的CLBP患者；(4)无慢性疼痛的患者长期使用美沙酮维持。约翰逊博士将利用临床和行为评估、定量感觉测试和各种神经成像技术来解决这一主要目标。在先进的神经成像方法和分析方面的教学和个性化培训将使约翰逊博士能够应用新方法来检测长期使用阿片类药物的影响。第二个研究目的是确定经颅磁刺激（TMS）对前额叶皮层损伤性加工的影响。经颅磁刺激是治疗慢性疼痛的潜在治疗工具，约翰逊博士将继续进行翻译研究方面的培训。最终，拟议的研究将推进关于长期使用阿片类药物的影响的知识，以及TMS成为治疗慢性疼痛的非阿片类药物治疗的潜力。通过5年的奖励期，约翰逊博士将在一个有指导的环境中获得领导研究的经验。在此奖项的培训和研究的基础上，他将申请独立资金，以进一步研究目前的阿片类药物治疗方法，并开发新的治疗疼痛的方法。

DESCRIPTION (provided by applicant): This application is for a Mentored Career Development Award (K23) to support Dr. Kevin Johnson's research and training in patient-oriented research related to understanding the central mechanisms of chronic pain, addiction and their intersection. Chronic pain conditions have a tremendous societal and personal impact. The treatment of chronic pain with long-term opioids may lack efficacy and even induce hyperalgesia. Methadone maintenance is a treatment for substance abuse, but the impact of long-term methadone on pain systems is not well-characterized. Dr. Johnson has a unique educational background in biomedical engineering, psychology, neuroscience, nursing, and patient-oriented neuroscience research. He will gain further training in the conduct of research, with a specialized focus on patients with chronic low back pain (CLBP) and on patients with methadone maintenance treatment for substance abuse. The first primary research aim is to characterize the effects of long-term opioid use on pain processing, using the follow participant groups: (1) healthy controls (2) control patients with CLBP taking no opioids, (3) patients with CLBP on long-term opioids, and (4) patients with no chronic pain on long-term methadone maintenance. Dr. Johnson will utilize clinical and behavioral assessments, quantitative sensory testing, and a variety of neuroimaging techniques to address this primary aim. Didactic and individualized training in advanced neuroimaging methods and analysis will allow Dr. Johnson to apply novel approaches for detecting the effects of long-term opioid use. The second research aim is determine the effects of Transcranial Magnetic Stimulation (TMS) over prefrontal cortex on nociceptive processing in each of the participant groups. TMS is a potential therapeutic tool for treating chronic pain, and Dr. Johnson will pursue training in translation research. Ultimately, the proposed research will advance knowledge regarding the effects of long-term opioid use and the potential for TMS to become a non-opioid therapy for treating chronic pain. Through the 5 years of this award period, Dr. Johnson will gain experience leading research in a mentored environment. Building on the training and research of this award, he will apply for independent funding to further investigate current opioid treatments approaches and to develop novel therapies for managing pain. PUBLIC HEALTH RELEVANCE: This training award will develop Dr. Johnson as patient-oriented researcher in the intersecting fields of pain and addiction. His research will focus on the potential negative effects of long-term opioid use on pain processing. He will also evaluate non-invasive brain stimulation (TMS) as a tool to alter pain processing, which would demonstrate the potential of TMS as a non-pharmacologic treatment for pain.