Progressive Activity-Based Rehabilitation in Veteran Cancer Survivors with Chronic Pain

患有慢性疼痛的老癌症幸存者的渐进式基于活动的康复

• 批准号: 10222617
• 负责人: ALICE S. RYAN
• 金额: --
• 依托单位: BALTIMORE VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-12-01 至 2022-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10222617
• 关键词: Adult; Aftercare; Asbestos; Cancer Survivor; Caring; Chemotherapy-induced peripheral neuropathy; Chronic; Coupled; Development; Diagnosis; Disease; Early Diagnosis; Enrollment; Excision; Exercise; Exposure to; Fatigue; General Population; Goals; Healthcare Systems; Incidence; Individual; Intervention; Investigation; Lead; Literature; Lung; Malignant Neoplasms; Malignant neoplasm of lung; Maryland; Medication Management; Modality; Modeling; Muscle; Non-Small-Cell Lung Carcinoma; Operative Surgical Procedures; Opioid; Outcome; Pain; Pain Threshold; Pain management; Patients; Persistent pain; Pharmaceutical Preparations; Phase; Physical Function; Physical activity; Population; Quality of life; Radon; Recording of previous events; Rehabilitation therapy; Research; Research Priority; Risk; Self Management; Sensory Thresholds; Services; Smoking; Supervision; Survivors; Symptoms; Thoracotomy; Time; United States; Uranium; Veterans; Work; addiction; agent orange; base; carcinogenicity; chemotherapy; chronic neuropathic pain; chronic pain; disability; exercise program; exercise rehabilitation; exercise training; experience; fitness; functional decline; functional restoration; high risk; improved; military veteran; neurotoxic; opioid use disorder; pain reduction; pain symptom; painful neuropathy; prevent; programs; rehabilitation research; research and development; sedentary; sedentary lifestyle; survivorship; symptom management; symptom treatment

Veterans are at a higher risk for lung cancer and so early detection, treatment, and symptom management are critical. Treatment for lung cancer in those with early stage local disease includes surgery and chemotherapy. However, persistent or chronic neuropathic pain, either post-thoracotomy persistent pain (PTPP) or chemotherapy-induced peripheral neuropathy (CIPN) occurs in a majority of patients. Thus, not only is this neuropathic pain widespread; there is no way to prevent its development, and long-term use of opioids for control of symptoms could result in addiction. Ultimately, PTPP and CIPN can lead to long-term suffering and disability during the post-treatment phase. Exercise, a non-pharmacologic intervention, holds promise as a new modality for reducing treatment- related neuropathic pain and functional decline resulting from PTPP and CIPN. There is very limited research examining the effects of exercise rehabilitation in those who have undergone lung resection for non-small cell lung cancer (NSCLC), which represents about 85% of lung cancer cases. Engaging cancer survivors with chronic post-surgical or post-chemotherapy neuropathic pain in this SPiRE meets a unique VA SPiRE directive and serves an understudied population. [We hypothesize that lung cancer survivors with chronic pain have reduced fitness and strength, poor muscle quality, and high levels of fatigue. Our global hypothesis is that activity rehabilitation will reduce pain symptoms; which will be associated with improved fitness, functional mobility, and reduced fatigue in lung cancer survivors with chronic pain compared to a delayed entry control period. Twenty-seven Veterans with a NSCLC history and either PTPP or CIPN will be enrolled in a 6-week delayed entry control period + 6-week VA Maryland Health Care System (VAMHCS) supervised exercise rehabilitation program.] Specific Aims: [1) To determine the feasibility of conducting an exercise rehabilitation intervention in Veterans with NSCLC and PTPP or CIPN. 2) To determine the effects of a VAMHCS-supervised activity rehabilitation program on chronic pain and sensory thresholds (thermal, static, and dynamic) compared to delayed control. 3) To assess changes in fitness, strength, physical function, fatigue, and quality of life (QoL) after activity- based rehabilitation compared to control period.] This is the first project of its kind and the potential impact of this research is large, because exercise training will be a prescription and the first approach for which NSCLC survivors can self-manage chronic neuropathic pain. The ultimate goal of our work is to reduce neuropathic pain for the growing population of cancer survivors while simultaneously reducing the need for problematic pharmacologic management. Therefore, results of this study have potential for high impact on symptom care because it will allow effective neuropathic pain treatment to be in full control of the Veteran, and likely restore function that is lost during the chronic pain experience.

退伍军人患肺癌的风险更高，因此早期发现，治疗和症状 管理至关重要。早期局部疾病患者的肺癌治疗包括手术 和化学疗法。但是，持续或慢性神经性疼痛，胸部切开术持续疼痛 （PTPP）或化学疗法诱导的周围神经病（CIPN）发生在大多数患者中。因此，不仅是 这种神经性疼痛是普遍的吗？无法防止其发展和长期使用阿片类药物 为了控制症状，可能会导致成瘾。最终，PTPP和CIPN会导致长期苦难 和治疗后的残疾。 锻炼是一种非药物干预措施，其有望是减少治疗的一种新方式 - PTPP和CIPN导致的相关神经性疼痛和功能下降。研究非常有限 检查接受非小细胞肺切除的人的运动康复的影响 肺癌（NSCLC）约占肺癌病例的85％。吸引癌症幸存者 该尖峰中的慢性手术后或化学后神经性疼痛符合独特的VA Spire指令 并为人口研究。 [我们假设患有慢性疼痛的肺癌幸存者已经 健身和力量降低，肌肉质量差以及疲劳水平高。我们的全球假设是 活动康复将减轻疼痛症状；这将与改善的健身和功能相关 与进入控制延迟的入口控制相比 时期。拥有NSCLC历史和PTPP或CIPN的27名退伍军人将入学6周 延迟入境控制期 + 6周VA马里兰医疗保健系统（VAMHCS）监督运动 康复计划。] 具体目的： [1）确定对NSCLC的退伍军人进行运动康复干预的可行性 和PTPP或CIPN。 2）确定VAMHCS监督活动康复计划对慢性疼痛和 与延迟对照相比，感觉阈值（热，静态和动态）。 3）评估活动后能力，力量，身体机能，疲劳和生活质量（QOL）的变化 - 与对照期相比，基于康复。] 这是同类项目的第一个项目，这项研究的潜在影响很大，因为运动训练 将是NSCLC幸存者可以自我管理的处方和第一种方法 疼痛。我们工作的最终目标是减轻癌症幸存者人群不断增长的神经性疼痛 同时减少了有问题的药理管理的需求。因此，结果 研究可能会对症状护理产生重大影响，因为它将允许有效的神经性疼痛治疗 充分控制退伍军人，并可能在慢性疼痛体验期间恢复功能。