Pain in PASC – The Role of Sleep Disturbances

PASC 疼痛 — 睡眠障碍的作用

• 批准号: 10511731
• 负责人: MONIKA HAACK
• 金额: $ 47.39万
• 依托单位: BETH ISRAEL DEACONESS MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-07-01 至 2024-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10511731
• 关键词: 18 year old; 2019-nCoV; Address; Age; Arthralgia; COVID-19 diagnosis; COVID-19 patient; Caring; Characteristics; Chronic; Clinical Research; Degenerative polyarthritis; Development; Diagnosis; Diffuse; Disease; Economic Burden; Environment; Exposure to; Fatigue; Female; Fibromyalgia; Functional disorder; Headache; High Prevalence; Home; Home environment; Hospitals; Impaired cognition; Impairment; Individual; Infection; Intervention; Knowledge; Laboratories; Lead; Light; Long COVID; Low Back Pain; Maintenance; Medical; Methodology; Methods; Modality; Monitor; Myalgia; Neuraxis; Pain; Pain-Free; Pathway interactions; Patients; Persistent pain; Persons; Polymerase Chain Reaction; Polysomnography; Population; Post-Acute Sequelae of SARS-CoV-2 Infection; Process; Reporting; Research; Rheumatoid Arthritis; Risk Factors; Role; SARS-CoV-2 infection; Sensory; Severities; Sleep; Sleep disturbances; Sleeplessness; Symptoms; Testing; Therapeutic; Time; Touch sensation; Translating; Visit; Work; actigraphy; acute infection; base; central pain; chronic pain; common symptom; comorbidity; diaries; disabling symptom; experience; falls; functional status; pain inhibition; pain processing; pain sensitivity; patient population; persistent symptom; post SARS-CoV-2 infection; pressure; prevent; sleep difficulty; sleep quantity; socioeconomics; somatosensory; spontaneous pain; therapeutic target; therapy design

PROJECT SUMMARY Up to 80% of individuals infected with SARS-CoV-2 continue to experience persistent and debilitating symptoms that extend >3 months into the post infection period, also called post-acute SARS-CoV-2 sequela (PASC) or ‘long COVID’. Pain is among the most common symptoms remaining after 6 months following the initial infection, along with sleep disturbance, fatigue, and cognitive impairment. The high prevalence rates of post-viral complications are alarming. There is an urgent need to understand the disease mechanisms and identify therapeutic targets. To date, factors such as the severity of the initial infection, medical co- morbidities, or age do not sufficiently explain who develops PASC and who does not. We hypothesize that sleep disturbance is a critical factor in the development and non-resolution of pain in PASC. Current research strongly indicates that sleep supports maintenance of a pain-free state and optimal functioning of central pain processing pathways. The proposed work will be the first to characterize the inter-relationship between sleep disturbance and pain in PASC patients. Twenty patients with PASC (PCR confirmed diagnosis of SARS-CoV-2), and 10 who had PCR confirmed infection but did not develop PASC (PASC+ and PASC-), will be included in this research (>18 years of age, 50% females). A comprehensive pain testing and sleep assessment approach consisting of at-home and in- laboratory subjective and objective monitoring methodologies will be used to address the following aims: Aim 1 will characterize pain in PASC+ compared with PASC-. We will (a) monitor day-to-day spontaneous/ongoing pain in the at-home environment, and (b) assess somatosensory deficits using quantitative somatosensory testing (QST) during the in-hospital Clinical Research Center (CRC) visit. We will evaluate the functional status of somatosensory modalities of touch, warmth, pressure, heat, and cold, as well as the capacity of the central nervous system (CNS) to modulate pain. Aim 2: will address the strength of association and directionality between indicators of sleep disturbance and spontaneous pain/somatosensory functioning in PASC. Indicators of sleep disturbances will be assessed by (a) day-to-day diary- and actigraphy-based monitoring of sleep in the at-home environment, and (b) polysomnography (PSG) in the in-hospital environment to evaluate macro- and microstructural sleep characteristics. The proposed work will be the first study to explore the role of sleep disturbance in the persistence and non-resolution of pain in PASC. Knowledge gained has the potential to influence therapeutic strategies aimed at normalizing pain in PASC, including addressing sleep difficulties as a first intervention to prevent the development of chronic pain in this patient population.

项目摘要 多达80％的感染SARS-COV-2的人继续经历持久和使人衰弱 延伸到感染后3个月的症状，也称为急性后SARS-COV-2续集 （PASC）或“长卷”。疼痛是疼痛后6个月后剩下的最常见的症状之一 初始感染，以及睡眠障碍，疲劳和认知障碍。高患病率 病毒后并发症令人震惊。迫切需要了解疾病机制和 确定治疗靶标。迄今为止，诸如初始感染的严重程度，医疗共同的因素 病态或年龄不能充分解释谁发展了PASC，谁没有。我们假设这一点 睡眠障碍是PASC疼痛发展和非分辨率的关键因素。当前的 研究强烈表明睡眠支持维持无痛状态和最佳功能 中央疼痛处理途径。拟议的工作将是第一个表征相互关系的工作 PASC患者的睡眠障碍与疼痛之间。 20例PASC患者（PCR确认的SARS-COV-2诊断），有10例已确认PCR已确认 感染但没有发展PASC（PASC+和PASC-），将包括在这项研究中（> 18岁， 50％女性）。全面的疼痛测试和睡眠评估方法，包括在家和内部 实验室主观和客观监测方法将用于解决以下目的： 与PASC-相比，AIM 1将表征PASC+的疼痛。我们将（a）日常监视 在家环境中的赞助/持续疼痛，（b）评估体验定义 院内临床研究中心（CRC）访问期间的定量体感测试（QST）。我们将 评估体感的触摸，温暖，压力，热和冷的功能状态 作为中枢神经系统（CNS）调节疼痛的能力。 目标2：将解决睡眠障碍指标之间的关联和方向性的强度 PASC中的赞助疼痛/体感功能。睡眠障碍的指标将是 由（a）基于（a）基于（基于行为摄影的日记）对睡眠的监视，以及 （b）在院内环境中评估宏观和微结构睡眠的多个术语（PSG） 特征。 拟议的工作将是探索睡眠灾难在持久性和 PASC疼痛的非分辨率。获得的知识具有影响理论策略的潜力 旨在使PASC的疼痛正常化，包括解决睡眠困难，以防止 该患者人群的慢性疼痛发展。