Central Sensitization and Sleep Disturbance as Predictors of Treatment Outcomes in Patients with Knee Osteoarthritis

中枢敏化和睡眠障碍作为膝骨关节炎患者治疗结果的预测因素

• 批准号: 10456895
• 负责人: Claudia Michelle Campbell
• 金额: $ 40.31万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-08-01 至 2025-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10456895
• 关键词: Address; Advocate; Affect; Ancillary Study; Body mass index; Caring; Clinical; Coping Skills; Degenerative polyarthritis; Economic Burden; Effectiveness; Elderly; Equipment; Evaluation; Funding; Future; Goals; Heterogeneity; High Prevalence; Hyaluronic Acid; Hyperalgesia; Hypersensitivity; Impairment; Individual; Individual Differences; Injections; Injury; Intervention; Knee Osteoarthritis; Knee joint; Knowledge; Laboratories; Lead; Life Expectancy; Link; Literature; Longterm Follow-up; Maintenance; Measures; Modeling; Nerve; Nerve Block; Neuraxis; Nociception; Operative Surgical Procedures; Opioid; Outcome; Outcome Measure; Pain; Pain Disorder; Pain management; Patient Outcomes Assessments; Patients; Pattern; Peripheral; Persistent pain; Persons; Phase; Phenotype; Physical Function; Population; Procedures; Public Health; Questionnaires; Radiofrequency Interstitial Ablation; Randomized Controlled Trials; Reporting; Resources; Risk; Role; Selection for Treatments; Sensory; Severities; Shapes; Site; Sleep; Sleep Apnea Syndromes; Sleep Deprivation; Sleep disturbances; Sleeplessness; Societies; Sum; Symptoms; Testing; Time; Treatment outcome; behavioral pharmacology; central sensitization; chronic pain; chronic painful condition; clinical pain; compare effectiveness; design; disability; duloxetine; effective intervention; experience; functional disability; global health; improved; improved outcome; indexing; knee replacement arthroplasty; neurotransmission; opioid therapy; osteoarthritis pain; pain chronification; pain model; pain processing; parent project; patient response; patient subsets; poor sleep; precision medicine; predicting response; radiological imaging; recruit; response; skills training; standard care; transmission process; treatment comparison; treatment response

PROJECT SUMMARY/ABSTRACT Knee osteoarthritis (KOA) is one of the leading causes of chronic pain and disability worldwide, affecting over 30% of older adults, and represents a major global health and economic burden to individuals and society. The rates of KOA have more than doubled in the past 70 years and continue to grow sharply, given increases in life expectancy and population BMI. Surgery is often used to treat KOA, but is associated with a high rate of persistent pain and is not a permanent solution. Numerous nonsurgical therapies have been advocated to treat pain in patients with KOA. A growing literature documents enhanced central nervous system pain processing, known as central sensitization (CS), which produces widespread sensitivity, among KOA patients. Sleep disturbance is associated with CS but imparts a terrible burden on patients suffering from pain in its own right. Both CS and sleep disturbance are hallmarks of various chronic pain conditions and important treatment considerations, with both independently being associated with the initiation and maintenance of pain and heightening pain severity . The parent project, which provides the platform for the current proposal, will evaluate behavioral, pharmacologic, and procedural interventions for KOA; a step-care model that allows for multiple treatment comparisons and phenotyping to improve selection for each therapy, which is expected to refine outcomes and reduce unnecessary interventions. The results of this study, which will follow pragmatic principles in order to maximize the information provided to stakeholders, will address not only the effectiveness of each tested intervention but also provide meaningful information regarding effectiveness across key subgroups of patients. However, the parent project will not assess CS or sleep disturbance, due to the additional expertise, expense, equipment and time required. A mechanistic evaluation of these factors is required to substantiate their impact on treatment response. The current proposal seeks to substantiate whether the conceptual understanding of these factors is legitimate. The project will also evaluate whether advanced understanding of CS and sleep disturbance are important contributions on top of the more easily quantified phenotypes collected in the parent project. The knowledge gained will inform patient phenotyping to better match patients with effective interventions, ultimately reducing the substantial heterogeneity across intervention outcomes and reliance on opioid therapies.

项目概要/摘要 膝骨关节炎 (KOA) 是全世界慢性疼痛和残疾的主要原因之一，影响超过 30% 的老年人，对个人和社会构成了重大的全球健康和经济负担。这 过去 70 年来，KOA 的发病率增加了一倍多，而且随着寿命的延长，KOA 的发病率继续急剧增长 预期和人口体重指数。手术通常用于治疗 KOA，但手术发生率较高 持续的疼痛并不是永久的解决方案。人们提倡采用多种非手术疗法来治疗 KOA 患者的疼痛。越来越多的文献记录了中枢神经系统疼痛处理的增强， 称为中枢敏化（CS），可在 KOA 患者中产生广泛的敏感性。睡觉 紊乱与 CS 相关，但给本身患有疼痛的患者带来了可怕的负担。 CS 和睡眠障碍都是各种慢性疼痛的标志，也是重要的治疗方法 考虑因素，两者独立地与疼痛的发生和维持相关 加剧疼痛严重程度 。为当前提案提供平台的父项目将评估 KOA 的行为、药理学和程序干预；允许多次护理的分步护理模式 治疗比较和表型分析，以改善每种治疗的选择，预计将进一步完善 成果并减少不必要的干预。本研究的结果将遵循务实的 为了最大限度地向利益相关者提供信息的原则，不仅要解决有效性 每个测试的干预措施的结果，还提供有关关键有效性的有意义的信息 患者亚组。然而，父项目不会评估 CS 或睡眠障碍，因为 需要额外的专业知识、费用、设备和时间。这些因素的机械评估是 需要证实它们对治疗反应的影响。目前的提案旨在证实 对这些因素的概念性理解是否合理。该项目还将评估是否 对 CS 和睡眠障碍的深入了解是更容易理解的重要贡献 在父项目中收集的量化表型。获得的知识将为患者表型分析提供信息 更好地为患者提供有效的干预措施，最终减少患者之间的实质性异质性 干预结果和对阿片类药物治疗的依赖。