Pathophysiology of Active and Latent Myofascial Trigger Points

主动和潜在肌筋膜触发点的病理生理学

基本信息

批准号：
10352066
负责人：
ALBERT F MORASKA
金额：
$ 22.46万
依托单位：
UNIVERSITY OF COLORADO DENVER
依托单位国家：
美国
项目类别：
财政年份：
2022
资助国家：
美国
起止时间：
2022-05-01 至 2024-04-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10352066
关键词：
ASIC channel Address Assessment tool Biological Markers Blood flow Branched-Chain Amino Acids Carbohydrates Carbon Carpal Tunnel Syndrome Cell physiology Cellular Stress Ceramides Chemicals Clinical Contracts Crohn&apos s disease Degenerative polyarthritis Development Disease Educational workshop Environment Exhibits Functional disorder Funding Opportunities Glucose Glycerol Goals Headache Health Helping to End Addiction Long-term Individual Inflammation Intercellular Fluid Intervention Intervention Trial Investigation Ischemia Lead Link Low Back Pain Malignant Neoplasms Massage Measures Medical Metabolic Metabolism Microdialysis Mind-Body Intervention Modeling Muscle Myalgia Myofascial Pain Syndromes Myofascial Trigger Point Neurons Nociceptors Nodule Outcome Output Pain Palpable Palpation Parkinson Disease Pathway interactions Patients Physical Examination Physiological Physiology Postoperative Pain Prevention strategy Pyrrolidonecarboxylic Acid Pyruvate Research Resolution Respiration Running Sampling Site Skeletal Muscle Sphingolipids Study models Suggestion Symptoms System Techniques Tension Headache Testing Tissues Treatment Effectiveness Triglycerides United States National Institutes of Health Vertebral column base cancer pain chronic pain clinical pain clinically relevant effective therapy energy balance experience experimental study insight interstitial ischemic injury lipid metabolism metabolome metabolomics osteoarthritis pain pain reduction pain sensitivity physical state predictive modeling prevent relating to nervous system response screening targeted treatment trapezius muscle treatment strategy trigger point ultrasound

项目摘要

PROJECT SUMMARY Pain deriving from a range of health concerns including headache, low back pain, osteoarthritis, carpal tunnel syndrome, as well as post-surgical and cancer pain have been linked to myofascial trigger points (TrPs). The TrP is a tender nodule along a taut band of muscle. Two states of the TrP are known to exist: active and latent. In the active state, the TrP is spontaneously painful and elicits pain referral mimicking the clinical complaint. The latent TrP is not spontaneously painful and any referred pain it elicits upon palpation is not related to a clinical pain complaint; the latent TrP is thought to be an intermediary state between healthy and an active TrP. Evidence from ultrasound indicates latent TrPs exhibit reduced blood flow, which is further reduced in active TrPs, suggestive of metabolic disruption and cellular stress. In line with that observation, hypothesized TrP models predict reduced glucose and elevated lactate in TrPs, however a pilot massage intervention trial that reduced active TrP pain found no change in glucose and an increase in lactate. The discrepancy between the TrP model and empirical evidence argues that cellular metabolism within a TrP may behave differently than the well-accepted model predicts. Lactate has also been linked to nociceptor sensitization, which could explain differences in local or referred pain experience. Furthermore, the differences in blood flow between latent and active TrPs could result in metabolic differences that may be informative as to the formation, progression, and perpetuation of TrPs. The present study will use a targeted and non-targeted metabolomics approach to understand the metabolic environment within both types of trigger points and healthy muscle. Latent TrPs from healthy individuals and active TrPs from individuals with tension-type headache will be investigated. The targeted approach will focus on glucose and lactate to determine whether carbohydrate energy balance is different within healthy muscle and trigger point sites. The non-targeted approach will screen for thousands of metabolic biomarkers within healthy muscle and the TrPs to identify relative differences in metabolites that could identify which metabolites lead to development of a latent TrP, progression to an active TrP, or perpetuation of the active TrP. The experiments described in this proposal will provide insight into the internal environment of TrPs. Should this exploratory study reveal disruption to carbohydrate energy balance or identify differences in biomarkers within latent or active TrPs a mechanism for the formation or progression of the TrP will become clear. This information could be used to optimize intervention techniques that will reverse or prevent muscle-derived pain. This proposed study will address the key goal to “Develop and validate biomarkers for chronic pain or other key symptoms to be used in studies of mind and body approaches” from the Funding Opportunity Announcement PA-18-322.

项目概要由一系列健康问题引起的疼痛，包括头痛、腰痛、骨关节炎、腕管综合症以及手术后和癌症疼痛都与肌筋膜触发点（TrP）有关。 TrP 是沿着紧绷的肌肉带的压痛结节，已知存在两种状态：活动状态和潜伏状态。在活跃状态下，TrP 会自发疼痛，并引发模仿临床主诉的疼痛转诊。潜在的 TrP 不会自发疼痛，触诊时引起的任何牵涉痛与疼痛无关。临床疼痛主诉；潜伏性 TrP 被认为是健康和活跃 TrP 之间的中间状态。来自超声的证据表明，潜在的 TrP 表现出血流量减少，而活性的 TrP 则进一步减少。 TrPs 表明代谢紊乱和细胞应激，与该观察一致，捕获了 TrPs。模型预测 TrP 中葡萄糖含量降低和乳酸升高，然而一项试点按摩干预试验表明减少活性TrP疼痛没有发现葡萄糖变化和乳酸增加之间的差异。 TrP 模型和经验证据表明，TrP 内的细胞代谢行为可能与公认的模型预测，乳酸也与伤害感受器敏化有关，这可以解释。此外，潜在疼痛和牵涉疼痛体验之间的血流量也存在差异。活性 TrP 可能导致代谢差异，这些差异可能为形成、进展和代谢提供信息。 TrP 的永久化。本研究将使用靶向和非靶向代谢组学方法来了解代谢来自健康个体和健康肌肉的两种触发点和健康肌肉中的环境。将研究来自紧张型头痛患者的活性 TrP。葡萄糖和乳酸以确定健康肌肉内碳水化合物能量平衡是否不同非靶向方法将筛选其中数千个代谢生物标志物。健康肌肉和TrPs来相对识别代谢物的差异，从而可以识别哪些代谢物导致潜在 TrP 的发展、进展为活性 TrP 或活性 TrP 的永久化。本提案中描述的实验将提供对 TrPs 内部环境的深入了解。这项探索性研究揭示了碳水化合物能量平衡的破坏或确定了生物标志物的差异在潜在或活跃的 TrP 中，TrP 的形成或进展机制将变得清晰。信息可用于优化干预技术，从而逆转或预防肌肉源性疼痛。这项拟议的研究将解决“开发和验证慢性疼痛或其他疾病的生物标志物”的关键目标用于身心方法研究的关键症状”来自资助机会公告 PA-18-322。