Identifying neural pathophysiology in juvenile fibromyalgia

确定青少年纤维肌痛的神经病理生理学

• 批准号: 10468863
• 负责人: Robert C Coghill
• 金额: $ 39.28万
• 依托单位: CINCINNATI CHILDRENS HOSP MED CTR
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-08-01 至 2024-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10468863
• 关键词: Adolescent; Adult; Aerobic Exercise; Affect; Affective; Aftercare; Ancillary Study; Anxiety; Brain; Brain Mapping; Brain imaging; Characteristics; Child; Clinical; Cognitive Therapy; Data; Development; Dimensions; Disease; Disease Management; Early Diagnosis; Exercise; Fatigue; Female; Female Adolescents; Fibromyalgia; Foundations; Functional Magnetic Resonance Imaging; Functional disorder; Funding; Goals; Hypersensitivity; Judgment; Kentucky; Laboratory Finding; Lead; Location; Machine Learning; Measures; Mental Depression; Modeling; Motor; National Institute of Arthritis and Musculoskeletal and Skin Diseases; Neurologic; Ohio; Output; Pain; Pain Measurement; Pain Research; Pain intensity; Painless; Parents; Parietal; Patients; Pattern; Persistent pain; Physical Function; Physiological; Prediction of Response to Therapy; Randomized Clinical Trials; Recommendation; Research; Sampling; Sensory; Site; Specific qualifier value; Stigmatization; Stimulus; Symptoms; Techniques; Testing; Time; Training; United States National Institutes of Health; base; brain abnormalities; chronic painful condition; cingulate cortex; clinical pain; clinical predictors; cohort; critical period; depressive symptoms; disability; fibromyalgia patients; hands-on learning; innovation; multisensory; neural correlate; neural patterning; neuromuscular; neurophysiology; pain symptom; parent project; physical symptom; psychologic; psychological symptom; relating to nervous system; response; treatment effect; treatment response

ABSTRACT Juvenile-onset fibromyalgia (JFM) is a debilitating, chronic pain condition affecting adolescents, primarily females, during a critical period for brain development, and that persists into adulthood for the majority of patients. Due to the lack of definite physical or laboratory findings, JFM has been questioned as a clinical entity, and sometimes regarded as merely an expression of anxiety or depression. This leads to poor understanding, stigmatization, and appropriate disease management, underscoring the need for identifying objective pathophysiology. We have previously used machine learning applied to fMRI data to yield multivariate patterns of distributed brain activity that, together, can identify test subjects as adult FM patients vs. healthy adults with high cross-validated accuracy (93%). However, extrapolating adult FM brain abnormalities to JFM is problematic, given the many factors impacting the developing adolescent brain and the clinical differences between adult and juvenile forms of the disease. The goal of this proposal is to identify brain pathophysiology characteristic of JFM during tailored symptom provocation tasks. There is currently a complete lack of research into the brain correlates of pain in children with widespread pain/JFM. This study will lay the foundation for a line of research in understanding the neurophysiologic underpinnings of JFM, discovering whether brain pathophysiology in JFM differs from adult FM, and assessing treatment effects on specific markers of brain pathophysiology. This study is an R01 ancillary study to the NIH/NIAMS-funded trial (R01 AR070474; Kashikar-Zuck), “Multi-site randomized clinical trial of Fibromyalgia Integrative Training for Juvenile Fibromyalgia (FIT Teens)”. The exceptionally well characterized cohort of JFM patients from the parent trial presents a unique opportunity to study JFM neural correlates. Our time-sensitive study will transform the scientific output of the parent project by identifying neurophysiological correlates of pain, psychological and physical symptoms in this large, representative, extensively-characterized sample of JFM patients before and after treatment. We hypothesize that machine learning applied to fMRI data during tailored symptom-provocation tasks will identify patterns of neural activity predictive of JFM status (vs. healthy), which will correlate with JFM symptom dimensions (pain, non-painful sensory hypersensitivity, fatigue, and depressive symptoms). This ancillary study will utilize the comprehensive psychological and physical functioning profiles already being captured in the parent R01 trial to identify clinically meaningful neurologic measures in JFM and explore the potential for these measures to change with treatment. This line of research has the potential for a profound impact on understanding and identifying JFM pathophysiology and providing neuro-physiologically informed treatment recommendations.

抽象的 少年发作的纤维肌痛（JFM）是一种令人衰弱的，慢性疼痛的青少年，主要是 女性，在大脑发育的关键时期，大多数人都持续到成年 患者。 实体，有时被视为焦虑或沮丧的表达。 理解，污名化，稳定识别的需求 客观的病理生理学。 分布式大脑活动的多元模式，可以将测试受试者识别为成人FM患者 与健康的成年人相互验证的精度（93％）。 鉴于影响未发育中的大脑及其的影响因素的许多因素影响因素的影响因素及其异常 成人和青少年形式的临床差异。 JFM在量身定制的症状挑衅任务中的脑病理生理特征。 完全缺乏对疼痛疼痛的大脑相关的研究/J​​FM。 为理解JFM的神经生理基础的研究奠定基础 发现JFM中的脑病理生理学是否与成人FM有所不同，并评估了对珍贵的影响 大脑病理生理学的特定标记。 （R01 AR070474; Kashikar-Zuck），“纤维肌痛整合整合训练的多站点随机临床试验 青少年纤维肌痛（适合青少年）。 家长试验提出了研究JFM神经相关性的独特机会。 通过识别疼痛的神经潜行相关性来改变母体项目的科学输出， 在这个大的，特征的JFM样本中，心理局限和身体症状 治疗前后的患者。 症状提供任务将确定JFM状态（与健康）的神经活动模式，该模式 将与JFM症状维度相关（疼痛，无疼痛的感觉超敏反应，疲劳和 抑郁症状）。 在父r01试验中捕获的捕获的功能型alreatady，以识别临床餐 JFM中的措施并探索了这些研究线的潜力。 有可能对理解和识别JFM病理生理学产生深远影响并提供 神经学知情的治疗建议。