Sensory Function and Chronic Pain in Cerebral Palsy

基础模型和慢性疼痛人群中疼痛研究的科学进展很少被转化为 应用于改善我们对疼痛和残疾的临床理解，这些患者有显著的 与神经发育障碍相关的智力、运动和沟通障碍。尽管 脑瘫(CP)慢性疼痛的负担是儿科发病的最常见原因，有很好的文献记载 终身运动和发育障碍，对感觉功能与 慢性疼痛。CP病因、病理生理学和临床表现的异质性提示新的 可能有必要确定可测量的、可预测的患者表型特征 慢性疼痛结局的个体差异。目前用于CP的疼痛评估方法仅限于 他们根据可能与理解相关的感觉功能对CP患者进行分组的能力 疼痛的病理生理机制。大多数感官测试研究都是用CP进行的，虽然很重要 毫无疑问，它依赖于旨在评估受损的辨别触觉能力的感觉刺激 如两点辨别、纹理和形状知觉等反映了大感觉神经纤维的传入功能。 将感官测试方法结合起来同时评估损失和获得的工作很少 反映大纤维和小纤维传入完整性的感觉功能。这样做的具体目的是 应用是为了解决对CP感觉功能的有限科学理解，以最终减少 慢性疼痛的负担。作为弥合CP患者有充分证据的疼痛负担和 我们建议对CP中相对未被探索的疼痛机制进行客观标准化的研究 扩展改进的定量感官应用的(基于协议的)测量方法 儿童脑性瘫痪伴与不伴感觉功能检测(QST)方案的比较 慢性疼痛。我们的理由如下。首先，比较慢性疼痛和无痛患者的感觉功能 慢性疼痛组有可能揭示潜在的触觉/伤害性感觉功能的差异 对于提高我们对慢性前列腺炎和其他严重IDD人群慢性疼痛的理解具有很高的相关性。 第二，将QST应用于患有CP的儿童和青少年的大样本将为 调查感觉功能与个体和临床特征的关系，以及健康结果 确定可以指导疼痛治疗目标选择的新的定制变量(目前还没有这样的指南 现在)。第三，使用基于协议的方法为调查提供了一个重要的标准化环境 伤害性和炎症性相关的生物标志物。最后，QST的逻辑为探索性研究提供了基础 但由慢性/神经病症患者提供信息的感觉亚型结构(获得、丧失功能)的高度新颖的测试 疼痛研究文献，作为创建基于感觉功能的慢性CP疼痛分组的第一步。

Scientific advances from pain research in basic models and chronic pain populations are rarely translated and applied to improve our clinical understanding of pain and disability among individuals with significant intellectual, motor, and communicative impairments associated with neurodevelopmental disorders. Despite the well document burden of chronic pain in cerebral palsy (CP), the most common cause of pediatric-onset lifelong motor and developmental disability, there is relatively little known about sensory function in relation to chronic pain. The heterogeneity in CP etiology, pathophysiology, and clinical appearance suggests new approaches may be warranted to identify measureable phenotypic patient characteristics predictive of individual variation in chronic pain outcomes. Current pain assessment approaches used in CP are limited in their ability to subgroup CP patients in relation to sensory function that may be relevant for understanding pathophysiological pain mechanisms. Most of the sensory testing research conducted with CP, while important and not in question, has relied on sensory stimuli designed to assess impaired discriminative tactile abilities such as two-point discrimination, texture and shape perception reflecting large sensory fiber afferent function. There has been little work incorporating sensory testing approaches that simultaneously evaluate loss and gain of sensory function reflecting both large and small fiber afferent integrity. The specific purpose of this application is to address the limited scientific understanding of sensory function in CP to ultimately reduce the burden of chronic pain. As a first step to close the gap between the well documented pain burden in CP and the relatively unexplored pain mechanisms in CP we are proposing to investigate an objective standardized (protocol-based) measurement approach by extending the application of a modified quantitative sensory testing (QST) protocol to characterize and compare sensory function in children with CP with and without chronic pain. Our reasoning is as follows. First, comparing sensory function between chronic pain and no chronic pain groups has the potential to reveal differences in underlying tactile/nociceptive sensory function with high relevance for improving our understanding of chronic pain in CP and other severe IDD populations. Second, applying QST to a large sample of children and adolescents with CP will provide the basis for investigating sensory function in relation to individual and clinical characteristics, and health outcomes to identify novel tailoring variables that could guide pain treatment target selection (no such guidelines exist right now). Third, using a protocol-based approach affords an important standardized context in which to investigate nociceptive and inflammatory relevant biomarkers. Finally, the logic of QST provides the basis for exploratory but highly novel tests of sensory subtype constructs (gain, loss of function) informed by the chronic/neuropathic pain research literature as a first step toward creating sensory-function based grouping of chronic pain in CP.