Nervous system influences on recovery from painful rotator cuff tears

项目总结 在过去的30年里，肩袖撕裂患者的临床结果并没有实质性的改善， 对于每年因肩袖撕裂而寻求医疗护理的450万美国人来说，这是一个问题。我们的长期合作 目标是通过确定最有可能受益的患者来最大化肩袖撕裂后的功能恢复 从有针对性的疼痛干预。这些知识对于优化受损疼痛的治疗是必要的。 正在处理。我们的中心假设是神经系统在症状严重程度和 复苏比人们通常认为的要好。这一假说的基本原理是基于 肩袖结构损伤与疼痛严重程度及结构不良程度之间的关系 损坏(即撕裂大小、缩回等)和功能恢复。Pozzi博士是一位物理治疗师，在 生物力学和运动学，将把他的研究带到一个新的方向，处理肩袖撕裂 从疼痛和神经科学的角度来看。波兹博士组建了一支拥有广泛临床经验、疼痛、 神经成像和疼痛神经学专业知识通过三个具体目标来验证他的中心假说：1)测试 肩部运动任务中的脑功能、损伤的慢性化和临床疼痛之间的关系 肩袖撕裂患者的症状；2)测试疼痛表型与慢性肩袖撕裂的关系 肩袖撕裂患者的损伤和临床疼痛症状；以及3)测试基线的有效性 气质特征、定量感觉测试和脑功能预测肩袖修复后的康复。 这个应用程序是创新的，因为我们将招募肩袖撕裂的三种损伤原因(创伤性- 症状、慢性症状和无症状)，这为研究慢性疼痛提供了关键优势。 我们在阐明神经系统如何应对突然和慢性肌腱丢失方面具有独特的地位。 有或没有疼痛症状的结构完整性。我们有可能测试特定的核心特征 急性肩袖引起的疼痛可能会变成慢性疼痛。我们设计了一个新颖的实验，在这个实验中我们将 在精确控制的次最大等长肩部收缩过程中获取脑功能图像。我们会 影响原发临床相关身体部位运动诱发疼痛的因素 症状，从而提供了潜在干预目标的证据。我们的研究将提供一个重要的 通过确定可能影响患者预后可变性的其他因素来做出贡献。此外，我们的 这些发现将推动我们朝着这一系列研究的长期目标前进：为精确的止痛药提供信息 考虑到有肩袖撕裂的个体的特定疼痛表型。中学到的知识 这项研究不会是渐进的；它将开启治疗肩袖撕裂患者的范式转变。

PROJECT SUMMARY In the last 30 years, clinical outcomes for individuals with rotator cuff tears have not substantially improved, which is problematic for the 4.5 million Americans that seek medical care for rotator cuff tears each year. Our long-term goal is to maximize functional recovery following rotator cuff tears by identifying patients most likely to benefit from targeted pain interventions. This knowledge is necessary to optimize treatments of impaired pain processing. Our central hypothesis is that the nervous system plays a larger role in symptom severity and recovery than conventionally believed. The rationale for this hypothesis is based on the disconnect between the rotator cuff structural damage and pain severity and the poor relationship between the extent of structural damage (i.e., tear size, retraction, etc.) and functional recovery. Dr. Pozzi, a physical therapist with expertise in biomechanics and movement science, will take his research in a new direction by approaching rotator cuff tears from pain and neuroscience perspectives. Dr. Pozzi assembled a team with extensive clinical, pain, neuroimaging, and pain-neuroscience expertise to test his central hypothesis through three specific aims: 1) test the association between brain function during a shoulder motor-task, chronicity of injury, and clinical pain symptoms in individuals with rotator cuff tears; 2) test the relationship between pain phenotypes, chronicity of injury, and clinical pain symptoms in individuals with rotator cuff tears; and 3) test the utility of baseline dispositional traits, quantitative sensory testing, and brain function to predict recovery following rotator cuff repair. This application is innovative because we will recruit the three injury etiologies of rotator cuff tears (traumatic- symptomatic, chronic-symptomatic, and asymptomatic), which provide a key advantage in studying chronic pain. We are uniquely positioned to shed light on how the nervous system reacts to sudden and chronic loss of tendon structural integrity with and without pain symptoms. We have the potential to test specific central features of acute rotator cuff-induced pain that may become chronic. We designed a novel experiment in which we will acquire functional brain images during precisely controlled submaximal isometric shoulder contractions. We will elucidate factors influencing movement-evoked pain of body areas associated with the primary clinical symptoms, thus providing evidence of potential intervention targets. Our study will provide a significant contribution by identifying additional factors that may influence the variability in patient outcomes. Further, our findings will move us toward the long-term goals of this line of investigation: informing precision pain medicine with consideration for specific pain phenotypes in individuals with rotator cuff tears. The knowledge gained in this study will not be incremental; it will springboard a paradigm shift in treating patients with rotator cuff tears.