Effects of Chronic Pain, Dyspnea, and Physical Activity Promotion on Functional Connectivity of the Brain in COPD

慢性疼痛、呼吸困难和体力活动促进对慢性阻塞性肺病患者大脑功能连接的影响

• 批准号: 10448237
• 负责人: Marilyn L. Moy
• 金额: --
• 依托单位: VA BOSTON HEALTH CARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-07-01 至 2024-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10448237
• 关键词: Affect; Award; Behavior; Biological Markers; Biology; Brain; Brain region; Cause of Death; Chronic Obstructive Pulmonary Disease; Clinical; Clinical Management; Communication; Complement; Complex; Couples; Disease; Dyspnea; Education; Elderly; Enrollment; Etiology; Event; Exercise; Feedback; Frontal gyrus; Funding; Future; Goals; Healthcare; Human; Inferior; Informal Social Control; Intervention; Lead; Magnetic Resonance Imaging; Measures; Medial; Mediating; Medical; Motivation; Musculoskeletal Pain; Narcotics; Nonpharmacologic Therapy; Opiate Addiction; Pain; Parietal Lobe; Participant; Patient Self-Report; Patients; Perception; Persons; Physical Exercise; Physical activity; Questionnaires; Randomized; Reporting; Research; Rest; Self Management; Sensory; Social support; Stimulus; Symptoms; Techniques; Technology; Testing; Veterans; Work; accurate diagnosis; accurate diagnostics; base; chronic back pain; chronic musculoskeletal pain; chronic pain; clinically relevant; deconditioning; design; diagnostic tool; exercise intervention; experience; functional status; health related quality of life; improved; insight; neuroimaging; novel; novel marker; online community; pain perception; pedometer; personalized care; personalized medicine; physical inactivity; respiratory; response; safety and feasibility; symptom management; symptom treatment; theories; treatment optimization; web site

COPD is the nation's third leading cause of death and affects up to 11% of all VA healthcare patients. Patients with COPD experience significant dyspnea despite optimization of medical therapy. In addition, over half of patients with COPD experience chronic pain--largely musculoskeletal pain. Clinically, in patients who suffer from both chronic pain and dyspnea, it is difficult to distinguish a patient's perception of one symptom modulated by the other. Novel objective diagnostic tools are needed to complement patient self-report and accurately distinguish symptoms in patients who have both chronic pain and dyspnea to optimize clinical management. It is also important to study chronic pain and dyspnea in COPD because they are common barriers to engaging in physical activity (PA) and exercise. The clinical course of COPD is characterized by a downward spiral of dyspnea and chronic pain, physical inactivity, and significant functional limitation. Although chronic pain and dyspnea can be barriers, PA and exercise are powerful, but underused, non-addictive therapies for management of these symptoms in COPD. We developed Every Step Counts (ESC), a technology-mediated intervention based on the Theory of Self-Regulation, to promote PA in COPD. We have demonstrated ESC's safety, feasibility, and efficacy to increase PA and improve health-related quality of life in Veterans with COPD. In two separate studies using questionnaires, ESC has been shown to improve dyspnea in COPD and relieve chronic back pain in Veterans. An important next step is to understand the mechanisms of benefit of PA interventions, like ESC, in the many COPD patients with both chronic musculoskeletal pain and dyspnea to ultimately design better PA interventions and optimize treatment of these symptoms. Currently, the central mechanisms of chronic pain and dyspnea, and how they change in response to PA promotion in COPD are largely unknown. It has been shown that pre-stimulus resting state functional connectivity determines pain perception in healthy humans. Resting state fcMRI evaluates interactions between brain regions before a sensory event or when an explicit task is not being performed. These communications are altered in older adults with chronic musculoskeletal pain. Functional connectivity among regions specifically within the “default mode” network (DMN) (posterior cingulate, inferior parietal lobes, and medial frontal gyrus) have been examined in clinical disease states, as this network is reliably detected and well-characterized. Functional connectivity may be a novel biomarker of chronic pain and dyspnea. Aim 1: Characterize and correlate the relationship between functional connectivity and chronic musculoskeletal pain and dyspnea in 30 persons with COPD (10 with both symptoms, 10 with chronic pain, and 10 with dyspnea). Aim 2: Explore changes in functional connectivity and changes in symptoms in 30 persons with COPD after use of the ESC intervention to increase PA. Our proposed design will leverage enrollment of well- characterized participants with COPD already using the ESC PA intervention as part of a distinct and ongoing RR&D Merit Award. This proposal will provide insight into the biologically complex relationships between symptoms (chronic pain and dyspnea), behavior (PA), and biology at the central level (functional connectivity).

慢性阻塞性肺病 (COPD) 是美国第三大死因，影响多达 11% 的 VA 医疗保健患者。 尽管优化了药物治疗，慢性阻塞性肺病患者仍会出现严重的呼吸困难。 一半的慢性阻塞性肺病患者会出现慢性疼痛——临床上主要是肌肉骨骼疼痛。 同时患有慢性疼痛和呼吸困难，很难区分患者对一种症状的感知 需要新的客观诊断工具来补充患者的自我报告和 准确区分同时患有慢性疼痛和呼吸困难的患者的症状，以优化临床 研究慢性阻塞性肺病的慢性疼痛和呼吸困难也很重要，因为它们很常见。 参与体力活动 (PA) 和锻炼的障碍 COPD 的临床病程的特点是： 呼吸困难和慢性疼痛、身体缺乏活动和显着的功能限制呈螺旋式下降。 慢性疼痛和呼吸困难可能是障碍，体能活动和运动很有效，但未得到充分利用，且不会上瘾 我们开发了一种治疗慢性阻塞性肺病 (COPD) 的“每一步都很重要”(ESC) 的疗法。 基于自我调节理论的技术介导干预，促进慢性阻塞性肺病的 PA 治疗。 ESC 的安全性、可行性和有效性被证明可以增加 PA 并改善健康相关的生活质量 在两项使用问卷调查的独立研究中，ESC 已被证明可以改善呼吸困难。 治疗慢性阻塞性肺病并缓解退伍军人的慢性背痛，下一步重要的是了解其机制。 PA 干预措施（如 ESC）对许多患有慢性肌肉骨骼疼痛的 COPD 患者有好处 和呼吸困难，最终设计更好的 PA 干预措施并优化这些症状的治疗。 目前，慢性疼痛和呼吸困难的核心机制，以及它们如何响应 PA 慢性阻塞性肺病（COPD）中的促进作用在很大程度上是未知的，已经表明刺激前静息状态有功能。 连接性决定健康人的疼痛感知 静息状态 fcMRI 评估相互作用。 在感觉事件之前或未执行明确任务时的大脑区域之间。 患有慢性肌肉骨骼疼痛的老年人之间的沟通发生改变。 特别是在“默认模式”网络（DMN）内的区域（后扣带回、下顶叶和 内侧额叶回）已在临床疾病状态中进行了检查，因为该网络已被可靠地检测到并 功能连接可能是慢性疼痛和呼吸困难的新生物标志物。 表征和关联功能连接与慢性肌肉骨骼疼痛之间的关系 30 名慢性阻塞性肺病患者出现呼吸困难（10 名同时出现两种症状，10 名患有慢性疼痛，10 名患有呼吸困难）。 目标 2：探索 30 名 COPD 患者术后功能连接的变化和症状的变化 使用 ESC 干预来增加 PA。我们提出的设计将利用良好的注册。 患有慢性阻塞性肺病的参与者已经使用 ESC PA 干预作为独特且持续的干预措施的一部分 RR&D 优异奖将深入了解生物之间的复杂关系。 症状（慢性疼痛和呼吸困难）、行为（PA）和中枢水平的生物学（功能连接）。