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).

COPD是美国第三大死亡原因，最多影响所有VA医疗保健患者中的11％。 COPD患者患有严重的呼吸困难，对医疗疗法的优化。另外，结束了 一半的COPD患者患有慢性疼痛 - 肌肉骨骼疼痛。临床上，在患者中 患有慢性疼痛和呼吸困难，很难区分患者对一种症状的看法 由对方调节。需要新颖的客观诊断工具来补充患者自我报告和 准确区分患有慢性疼痛和呼吸困难的患者的符号以优化临床 管理。研究COPD中的慢性疼痛和呼吸困难也很重要，因为它们很常见 进行体育锻炼（PA）和运动的障碍。 COPD的临床过程的特征是 呼吸困难和慢性疼痛，身体不活跃和显着功能限制的向下螺旋。虽然 慢性疼痛和呼吸困难可能是障碍，宾夕法尼亚州和运动功能强大，但没有用，无依据 在COPD中管理这些症状的疗法。我们开发了每个步骤计数（ESC），一个 基于自我调节理论的技术介导的干预措施，以在COPD中促进PA。我们有 展示了ESC的安全性，可行性和效率，以提高PA并改善与健康相关的生活质量 老兵与COPD。在两项使用问卷的单独研究中，ESC已被证明可以改善呼吸困难 在COPD中，救助退伍军人的慢性背痛。下一步的一个重要下一步是了解机制 在许多患有慢性肌肉骨骼疼痛的COPD患者中，PA干预的好处，例如ESC， 和呼吸困难最终设计更好的PA干预措施并优化对这些符号的处理。 目前，慢性疼痛和呼吸困难的中心机制，以及它们如何改变PA COPD中的晋升在很大程度上未知。已经表明，刺激前静止状态功能 连通性决定健康人的疼痛感。静止状态FCMRI评估交互 在感官事件之前或未执行明确任务之前，在大脑区域之间。这些 老年人患有慢性肌肉骨骼疼痛的老年人发生了变化。功能连通性 特别是在“默认模式”网络（DMN）中的区域（后扣带回，较低的顶壁爱和 在临床疾病状态下已经检查了培养基额回），因为该网络可靠地检测到，并且 特殊的。功能连通性可能是慢性疼痛和呼吸困难的新型生物标志物。目标1： 表征并关联功能连通性与慢性肌肉骨骼疼痛之间的关系 30人患有COPD的患者（两个症状，10例患有慢性疼痛，呼吸困难10）和呼吸困难。 目标2：探索功能连通性的变化和30人COPD的症状变化 使用ESC干预来增加PA。我们提出的设计将利用良好的入学 COPD的参与者的表征已经使用ESC PA干预作为独特而持续的一部分 RR＆D优异奖。该建议将为生物学上复杂的关系提供见识 症状（慢性疼痛和呼吸困难），行为（PA）和中央层的生物学（功能连通性）。