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较高，因此应及早发现、治疗和症状 管理至关重要。患有早期局部疾病的肺癌的治疗包括手术 和化疗。然而，持续性或慢性神经性疼痛，或者开胸术后持续性疼痛 (PTPP) 或化疗引起的周围神经病变 (CIPN) 发生在大多数患者中。因此，不仅 这种神经性疼痛是否普遍存在？没有办法阻止其发展，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 可能导致长期痛苦 以及治疗后阶段的残疾。 运动是一种非药物干预措施，有望成为减少治疗的新方式 PTPP 和 CIPN 导致的相关神经性疼痛和功能下降。研究非常有限 检查运动康复对接受非小细胞肺切除术的患者的影响 肺癌（NSCLC），约占肺癌病例的 85%。让癌症幸存者参与 该 SPiRE 中的慢性手术后或化疗后神经性疼痛符合独特的 VA SPiRE 指令 并服务于未被充分研究的人群。 [我们假设患有慢性疼痛的肺癌幸存者 体能和力量下降、肌肉质量差以及高度疲劳。我们的全球假设是 活动康复将减轻疼痛症状；这将与改善健康、功能性有关 与延迟进入控制相比，患有慢性疼痛的肺癌幸存者的活动能力和疲劳减轻 时期。 27 名有 NSCLC 病史且接受 PTPP 或 CIPN 的退伍军人将参加为期 6 周的项目 延迟入境控制期 + 6 周 VA 马里兰州医疗保健系统 (VAMHCS) 监督演习 康复计划。] 具体目标： [1) 确定对患有非小细胞肺癌的退伍军人进行运动康复干预的可行性 以及 PTPP 或 CIPN。 2) 确定 VAMHCS 监督的活动康复计划对慢性疼痛和 与延迟控制相比的感觉阈值（热、静态和动态）。 3) 评估活动后体能、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治疗。] 这是此类项目中的第一个，这项研究的潜在影响很大，因为运动训练 将成为非小细胞肺癌幸存者能够自我管理慢性神经病变的处方和第一个方法 疼痛。我们工作的最终目标是减少不断增长的癌症幸存者的神经性疼痛 同时减少有问题的药物管理的需要。因此，本次的结果 该研究对症状护理有很大影响，因为它将允许有效的神经病理性疼痛治疗 完全控制退伍军人，并可能恢复在慢性疼痛经历期间丧失的功能。