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

描述（由申请人提供）：本申请是一个辅导职业发展奖（K23），以支持博士凯文约翰逊的研究和培训，以病人为导向的研究有关了解慢性疼痛，成瘾及其交叉的中央机制。慢性疼痛状况具有巨大的社会和个人影响。长期使用阿片类药物治疗慢性疼痛可能缺乏疗效，甚至诱发痛觉过敏。美沙酮维持治疗是一种药物滥用的治疗方法，但长期美沙酮对疼痛系统的影响还没有得到很好的表征。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。他将获得进一步的培训，在研究的行为，与慢性腰痛（CLBP）和美沙酮维持治疗药物滥用的患者的专门重点。第一个主要研究目的是描述长期使用阿片类药物对疼痛处理的影响，使用以下参与者组：（1）健康对照（2）未服用阿片类药物的CLBP对照患者，（3）长期服用阿片类药物的CLBP患者，和（4）长期美沙酮维持治疗的无慢性疼痛患者。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。在先进的神经影像学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的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）对每个参与者组的前额叶皮层伤害性加工的影响。TMS是治疗慢性疼痛的潜在治疗工具，约翰逊博士将继续接受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以及TMS成为治疗慢性疼痛的非阿片类药物疗法的潜力的知识。通过5年的奖励期，约翰逊博士将获得在指导环境中领导研究的经验。在该奖项的培训和研究基础上，他将申请独立资金，以进一步研究当前的阿片类药物治疗方法，并开发用于管理疼痛的新疗法。

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.