Sleep and Pain Interventions in Fibromyalgia: Hyperalgesia and Central Sensitizat

描述（由申请人提供）： 大约50-70%的慢性疼痛患者，特别是纤维肌痛患者，报告睡眠困难。由于不可能在其他健康的参与者中随机诱导慢性疼痛或慢性失眠，因此睡眠/疼痛关系的确切性质尚未得到很好的理解。幸运的是，失眠（CBT-I）和疼痛（CBT-P）的认知行为治疗（CBT）提供了一个很好的机会来检查这两种疾病之间的因果关系。本研究旨在探讨纤维肌痛患者慢性疼痛与睡眠障碍之间的关系。 CBT-I和CBT-P将用于检查睡眠和疼痛之间的因果关系。具体目标1和2涉及一项随机临床试验（RCT），以评估CBT-I和CBT-P对失眠纤维肌痛患者的睡眠和疼痛的影响，而不是等待名单对照。睡眠可能在慢性疼痛状况的慢性化中发挥病因学作用。此外，慢性疼痛状况的维持可最终导致中枢致敏状态（背角神经元以及可能其他CNS结构对刺激的反应性增加）。具体目标3研究了改善睡眠对疼痛中枢敏感化的影响，具体目标4研究了疼痛减轻对睡眠结果改善的间接影响。我们建议测试特定的假设固有的认知激活理论的压力（CAT）。持续的唤醒和缺乏唤醒解决（即，通过安静的睡眠）与中枢敏感化的发展有关。与CAT模型一致的还有一个假设，即负面影响（例如，抑郁、焦虑）导致中枢敏感化。具体目标5研究疼痛、睡眠、负面情绪和中枢敏感化关系的多变量模型，作为纤维肌痛应激认知激活理论的检验。这两种假设都与我们实验室收集的初步数据一致，这些数据将慢性疼痛状况和纤维肌痛患者疼痛的中枢致敏性的负面影响联系起来。 公共卫生相关性段落：慢性疼痛背景下的慢性失眠是许多美国人的主要健康威胁。这项研究解决了公众对慢性失眠和慢性疼痛之间关系的信息需求，以及针对失眠（CBT-I）和疼痛（CBT-P）的认知行为干预在这一弱势群体中的影响。所获得的信息不仅对可能患有失眠和疼痛的其他患者群体（即，癌症患者），而且对于那些患有其他行为/健康问题的人（即，体重管理、抑郁症）。

DESCRIPTION (provided by applicant): Approximately 50-70% of patients with chronic pain, particularly fibromyalgia sufferers, report sleep difficulties. Because it is not possible to randomly induce chronic pain or chronic insomnia in otherwise healthy participants, the exact nature of the sleep/pain relationship is not well understood. Fortunately, established cognitive behavioral treatments (CBT) treatments for insomnia (CBT-I) and pain (CBT-P) offer an excellent opportunity to examine the causal links between these two disorders. The purpose of this study is to examine the relationship between chronic pain and sleep disturbance in fibromyalgia patients. CBT-I and CBT-P will be used to examine the causal links between sleep and pain. Specific Aims 1 and 2 involve a randomized clinical trial (RCT) to evaluate the effects on sleep and pain of CBT-I and CBT-P against a waitlist control in fibromyalgia patients with insomnia. Sleep may play an etiological role in the chronicity of chronic pain conditions. Furthermore, the maintenance of chronic pain conditions can ultimately lead to a state of central sensitization (increased responsiveness of dorsal horn neurons, and perhaps other CNS structures to stimuli). Specific Aim 3 investigates the effect of improved sleep on central sensitization of pain, and Specific Aim 4 investigates the indirect effects of pain reduction on improvements in sleep outcomes. We propose to test specific hypotheses inherent in the Cognitive Activation Theory of stress (CAT). Sustained arousal and lack of arousal resolution (i.e., through restful sleep) has been implicated in the development of central sensitization. Also consistent with the CAT model is the hypothesis that negative affect (e.g., depression, anxiety) leads to central sensitization. Specific Aim 5 investigates multivariate models of the relationship of pain, sleep, negative affect, and central sensitization as a test of the Cognitive Activation Theory of stress in Fibromyalgia. Both of these hypotheses are consistent with preliminary data collected in our laboratory linking both chronic pain conditions, and negative affect to central sensitization of pain in fibromyalgia patients. Public Health Relevance Paragraph: Chronic insomnia in the context of chronic pain represents a major health threat for many Americans. This research addresses the public health need for information on the relationship between chronic insomnia and chronic pain and the effect of cognitive behavioral interventions that target insomnia (CBT-I) and pain (CBT-P) in this vulnerable population. The information to be gained has broad implications not only for other patient populations likely to suffer from insomnia and pain (i.e., cancer patients), but also for those suffering from other behavioral/heath concerns (i.e., weight management, depression).