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。因为不可能随机地在其他健康的参与者中引起慢性疼痛或慢性失眠，所以睡眠/疼痛关系的确切性质还没有被很好地理解。幸运的是，公认的认知行为疗法(CBT)治疗失眠(CBT-I)和疼痛(CBT-P)提供了一个很好的机会来检查这两种疾病之间的因果联系。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将被用来检查睡眠和疼痛之间的因果联系。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对纤维肌痛失眠患者的睡眠和疼痛的影响。睡眠可能在慢性疼痛条件的慢性化中起到病因学作用。此外，慢性疼痛状态的维持最终可能导致中枢敏感化状态(背角神经元，也许还有其他中枢神经系统结构对刺激的反应增强)。特定目的3研究改善睡眠对疼痛中枢敏感化的影响，特定目的4研究减少疼痛对改善睡眠结果的间接影响。我们建议检验压力认知激活理论(CAT)所固有的特定假设。持续唤醒和缺乏唤醒解决(即，通过休息睡眠)与中枢敏感化的发展有关。与CAT模型一致的假设是，负面情绪(例如，抑郁、焦虑)会导致中枢敏感化。具体目的5研究疼痛、睡眠、负性情绪和中枢敏感化之间关系的多变量模型，作为对纤维肌痛应激认知激活理论的检验。这两个假说都与我们实验室收集的初步数据一致，表明纤维肌痛患者的慢性疼痛状况和对疼痛中枢敏感化的负面影响。 公共卫生相关段落：在慢性疼痛的背景下，慢性失眠对许多美国人来说是一个主要的健康威胁。这项研究解决了公共卫生对慢性失眠和慢性疼痛之间关系的信息需求，以及针对失眠和疼痛的认知行为干预(CBT-I)和疼痛(CBT-P)在这一脆弱人群中的效果。将获得的信息不仅对其他可能遭受失眠和疼痛的患者群体(即癌症患者)，而且对那些患有其他行为/健康问题(如体重管理、抑郁症)的患者具有广泛的影响。

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).