Sleep and Pain Interventions in Fibromyalgia: Hyperalgesia and Central Sensitizat

纤维肌痛的睡眠和疼痛干预：痛觉过敏和中枢敏化

• 批准号: 7941684
• 负责人: Christina S McCrae
• 金额: $ 33.43万
• 依托单位: UNIVERSITY OF FLORIDA
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-09-29 至 2012-09-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7941684
• 关键词: Address; Affect; Aftercare; American; Anxiety; Arousal; Behavior Therapy; Behavioral; Cancer Patient; Chronic; Chronic Insomnia; Clinical; Cognitive; Control Groups; Data; Development; Disease; Effectiveness; Evaluation; Experimental Designs; Fibromyalgia; Health; Hyperalgesia; Influentials; Intervention; Israel; Laboratories; Lead; Link; Literature; Maintenance; Measures; Mediating; Mediator of activation protein; Medical; Modeling; Names; Nature; Nociception; Outcome; Outcome Measure; Pain; Participant; Patients; Pattern; Play; Posterior Horn Cells; Price; Public Health; Publishing; Randomized; Randomized Clinical Trials; Relative (related person); Reporting; Research; Research Design; Resolution; Role; Sampling; Sleep; Sleep Architecture; Sleep Stages; Sleep disturbances; Sleeplessness; Staging; Stimulus; Stress; Structure; Symptoms; Testing; Time; Vulnerable Populations; Waiting Lists; Weight; Work; central sensitization; chronic pain; cognitive behavior therapy; depression; design; disturbance in affect; experience; improved; patient population; public health relevance; sleep onset; theories

DESCRIPTION (provided by applicant): Approximately 50-70% of patients with chronic pain, particularly fibromyalgia sufferers, report sleep difficulties. Because it is not possible to randomly induce chronic pain or chronic insomnia in otherwise healthy participants, the exact nature of the sleep/pain relationship is not well understood. Fortunately, established cognitive behavioral treatments (CBT) treatments for insomnia (CBT-I) and pain (CBT-P) offer an excellent opportunity to examine the causal links between these two disorders. The purpose of this study is to examine the relationship between chronic pain and sleep disturbance in fibromyalgia patients. CBT-I and CBT-P will be used to examine the causal links between sleep and pain. Specific Aims 1 and 2 involve a randomized clinical trial (RCT) to evaluate the effects on sleep and pain of CBT-I and CBT-P against a waitlist control in fibromyalgia patients with insomnia. Sleep may play an etiological role in the chronicity of chronic pain conditions. Furthermore, the maintenance of chronic pain conditions can ultimately lead to a state of central sensitization (increased responsiveness of dorsal horn neurons, and perhaps other CNS structures to stimuli). Specific Aim 3 investigates the effect of improved sleep on central sensitization of pain, and Specific Aim 4 investigates the indirect effects of pain reduction on improvements in sleep outcomes. We propose to test specific hypotheses inherent in the Cognitive Activation Theory of stress (CAT). Sustained arousal and lack of arousal resolution (i.e., through restful sleep) has been implicated in the development of central sensitization. Also consistent with the CAT model is the hypothesis that negative affect (e.g., depression, anxiety) leads to central sensitization. Specific Aim 5 investigates multivariate models of the relationship of pain, sleep, negative affect, and central sensitization as a test of the Cognitive Activation Theory of stress in Fibromyalgia. Both of these hypotheses are consistent with preliminary data collected in our laboratory linking both chronic pain conditions, and negative affect to central sensitization of pain in fibromyalgia patients. Public Health Relevance Paragraph: Chronic insomnia in the context of chronic pain represents a major health threat for many Americans. This research addresses the public health need for information on the relationship between chronic insomnia and chronic pain and the effect of cognitive behavioral interventions that target insomnia (CBT-I) and pain (CBT-P) in this vulnerable population. The information to be gained has broad implications not only for other patient populations likely to suffer from insomnia and pain (i.e., cancer patients), but also for those suffering from other behavioral/heath concerns (i.e., weight management, depression).

描述（由申请人提供）： 大约50-70％的慢性疼痛患者（尤其是纤维肌痛患者）报告睡眠困难。因为不可能在健康的参与者中随机诱导慢性疼痛或慢性失眠，所以睡眠/疼痛关系的确切性质尚不清楚。幸运的是，已建立的失眠（CBT-I）和疼痛（CBT-P）治疗的认知行为治疗（CBT）提供了一个很好的机会，可以检查这两种疾病之间的因果关系。这项研究的目的是检查纤维肌痛患者的慢性疼痛与睡眠障碍之间的关系。 CBT-I和CBT-P将用于检查睡眠和疼痛之间的因果关系。具体目的1和2涉及一项随机临床试验（RCT），以评估CBT-I和CBT-P对纤维肌痛失眠症患者的候补控制的影响和疼痛的影响。睡眠在慢性疼痛状况的慢性性中可能起病因的作用。此外，慢性疼痛条件的维持最终会导致中心敏化状态（背角神经元的响应性提高，也许还有其他CNS对刺激的结构）。具体目标3研究了改善睡眠对疼痛中心敏化的影响，而特定目标4研究了疼痛减轻对改善睡眠结局的间接影响。我们建议测试应力认知激活理论（CAT）固有的特定假设。持续的唤醒和缺乏唤醒分辨率（即，通过宁静的睡眠）与中央致敏的发展有关。同样与CAT模型一致的是，负面影响（例如抑郁症，焦虑）会导致中心敏化的假设。具体目的5研究了疼痛，睡眠，负面影响和中心敏化关系的多元模型，以测试纤维肌痛中压力的认知激活理论。这两个假设都与我们在实验室中收集的初步数据一致，该数据将慢性疼痛条件连接起来，以及纤维肌痛患者疼痛的中枢敏化的负面影响。 公共卫生相关性段落：在慢性疼痛的背景下，慢性失眠是许多美国人的主要健康威胁。这项研究涉及公共卫生对慢性失眠与慢性疼痛之间关系的信息以及针对失眠（CBT-I）和疼痛（CBT-P）的认知行为干预措施对这一脆弱人群的影响。要获得的信息不仅对可能患有失眠和疼痛的其他患者人群（即癌症患者）具有广泛的影响，而且对患有其他行为/荒地问题（即体重管理，抑郁症）的患者也具有广泛的影响。