Thermal Integrative Stimuli for Assessment of Neuropathic Pain after SCI

热整合刺激评估 SCI 后神经病理性疼痛

• 批准号: 8181310
• 负责人: Elizabeth Roy Felix
• 金额: --
• 依托单位: MIAMI VA HEALTH CARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-10-01 至 2012-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8181310
• 关键词: Activities of Daily Living; Advocate; Affect; Analgesics; Animal Model; Area; Burning Pain; Characteristics; Chronic; Clinical Research; Clinical Treatment; Cognitive; Complex; Conduct Clinical Trials; Data; Development; Diagnosis; Diagnostic; Disease; Emotional; Esthesia; Evaluation; Exhibits; Functional disorder; Future; Goals; Healthcare; High Prevalence; Illusions; Individual; Injury; Intervention; Investigation; Label; Lead; Lesion; Measurement; Measures; Medical center; Methods; Neurologic; Nociception; Outcome; Outcome Assessment; Outcome Measure; Pain; Pain Threshold; Pain intensity; Paraplegia; Participant; Pathway interactions; Patients; Persistent pain; Persons; Pilot Projects; Population; Positioning Attribute; Posture; Process; Process Assessment; Protocols documentation; Publications; Quadriplegia; Quality of life; Recovery of Function; Refractory; Rehabilitation therapy; Relative (related person); Reporting; Research; Response to stimulus physiology; Sensory; Sensory Process; Severities; Side; Skin; Spinal cord injury; Spinal cord injury patients; Stimulus; Symptoms; Syndrome; System; Techniques; Temperature; Testing; Translational Research; Treatment Efficacy; Validation; Veterans; Visual; Work; analog; chronic neuropathic pain; chronic pain; design; effective therapy; experience; human subject; improved; improved functioning; innovation; insight; neuromechanism; painful neuropathy; patient population; psychologic; receptor; response; somatosensory; spatial integration; spinal cord injury pain; successful intervention; tool

DESCRIPTION (provided by applicant): Chronic neuropathic pain is a particularly troublesome secondary consequence of spinal cord injury (SCI) which affects approximately 40% of persons with SCI. Despite the high prevalence of SCI-related neuropathic pain and its impact on rehabilitation efforts, current treatments for this type of pain are often ineffective. The development of more successful interventions for central neuropathic pain is limited by the fact that the mechanisms responsible for this type of pain are not clearly understood, and definitive diagnostic and outcome tools have yet to be established. Quantitative sensory testing (QST), which allows for noninvasive evaluation of somatosensory processing mechanisms in human subjects, has recently been advocated as a potentially critical tool for the investigation of neuropathic pain, including aiding in the validation of ratings of ongoing pain, in the evaluation of treatment efficacy, and in the successful translation of research from animal models to clinical treatment paradigms. The goal of the proposed pilot project is to examine the utility of specific QST measures, which are aimed at assessing the integrity of thermal and pain integrative sensory processing, for the assessment of neuropathic pain characteristics in persons with SCI. Because the methods to be employed in this pilot study have been reported in a very limited number of publications, the rationale for conducting this pilot project is to provide initial support for the hypotheses outlined below, which will guide the design of a full research protocol to thoroughly validate these QST techniques for neuropathic pain in SCI. Objective 1: Examine the relationship between the degree of spatial integration of thermal noxious stimulation and the presence of neuropathic pain in persons with SCI. Stimulus-response relationships will be measured by asking subjects to rate the intensity of pain produced by thermal stimuli of varying temperatures delivered using one thermal probe (9cm2 area) and those delivered using two thermal probes side-by-side (18cm2 total area). Spatial summation will be assessed by comparing the differences in pain intensity ratings for the small stimulus area (one probe) and the large stimulus area (two probes) across subjects. We hypothesize that greater differences in pain ratings between the two stimulus sizes (one probe vs. two probes) will occur in participants with SCI and neuropathic pain (i.e., greater spatial summation) compared to participants with SCI who do not have pain, suggesting enhanced integration of noxious inputs across space in persons who have neuropathic pain. Objective 2: Compare perceptual responses to the "thermal grill" stimulus between persons with SCI and neuropathic pain and persons with SCI who do not have pain. A thermal grill stimulus will be used to assess thermal and pain integration processes. The thermal grill, which is typically composed of a number of interlaced warm (40oC) and cool (20oC) stimulus bars presented simultaneously, produces a paradoxical "burning pain" sensation when presented to the skin of a person with intact somatosensory function. This experience of pain due to the thermal grill has been suggested to be abnormal in persons with neuropathic pain. In the proposed pilot study thermal grill-produced pain thresholds will be obtained in persons with SCI and neuropathic pain and in persons with SCI who do not have neuropathic pain. It is hypothesized that the thermal grill threshold for participants with neuropathic pain will be significantly higher than for participants without neuropathic pain, suggesting that the normal integration of information from warm and cool sensory pathways is disrupted in those with neuropathic pain. Results from the proposed pilot studies will yield insight regarding the specific somatosensory system mechanisms that may be related to the experience of neuropathic pain, and will provide support for future studies aimed at fully validating the use of these QST techniques as potential diagnostic and outcome measures for neuropathic pain in SCI.

描述（由申请人提供）： 慢性神经性疼痛是脊髓损伤（SCI）特别麻烦的次要后果，它影响了大约40％的SCI患者。尽管与科幻相关的神经性疼痛及其对康复工作的影响很高，但目前对这种类型疼痛的治疗往往是无效的。对中枢神经性疼痛进行更成功的干预措施的开发受到以下事实的限制：对这种类型的疼痛的机制尚未清楚地理解，并且尚未确定确定的诊断和结果工具。定量感觉测试（QST）允许对人类受试者的体感处理机制进行非侵染性评估，最近被提倡是研究神经性疼痛的潜在至关重要的工具，包括协助验证持续的疼痛等级，以评估治疗效率的治疗效率，在治疗效率上的疼痛，从而成功地翻译了动物模型。拟议的试点项目的目的是检查特定QST措施的实用性，旨在评估热和疼痛整合感觉处理的完整性，以评估SCI患者的神经性疼痛特征。由于在这项试验研究中使用的方法已在非常有限的出版物中进行了报道，因此进行该试点项目的理由是为下面概述的假设提供初始支持，这将指导完整的研究方案的设计，以彻底验证SCI中神经性疼痛的这些QST技术。 目标1：检查热刺激的空间整合程度与SCI患者中神经性疼痛的存在之间的关系。刺激反应关系将通过要求受试者评估使用一个热探针（9cm2面积）传递的温度变化的热刺激产生的疼痛强度，并使用两个热探针并排交付的疼痛强度（18cm2总面积）。将通过比较小刺激区域（一个探针）和大型受试者的较大刺激区域（两个探针）的疼痛强度等级的差异来评估空间求和。我们假设，与没有疼痛的参与者相比，SCI和神经性疼痛的参与者（即更大的空间求和）在参与者中将发生两个刺激大小之间的疼痛等级差异（一个探针与两个探针），这表明没有疼痛的参与者，这表明在跨空间中增加了患有神经疗法疼痛的人群中有不良输入的人。 目标2：比较SCI和神经性疼痛患者与SCI患者之间的“热烤架”刺激的感知反应。热烧烤刺激将用于评估热和疼痛整合过程。热烤架通常由许多交错的温暖（40oc）和凉爽（20oc）刺激棒组成，当表现在具有完整体感功能的人的皮肤上时，会产生矛盾的“燃烧疼痛”感觉。由于神经性疼痛的患者，由于热烤架引起的疼痛经历异常。在拟议的试点研究中，将在患有SCI和神经性疼痛的患者以及患有神经性疼痛的SCI患者中获得热烧烤产生的疼痛阈值。假设神经性疼痛的参与者的热烧烤阈值将显着高于没有神经性疼痛的参与者，这表明在神经性疼痛的患者中，来自温暖和凉爽感觉途径的信息正常整合受到暖和凉爽的感觉途径。 拟议的试点研究的结果将对可能与神经性疼痛经历有关的特定体感系统机制产生见解，并将为未来的研究提供支持，旨在充分验证这些QST技术作为SCI中神经性疼痛的潜在诊断和结果指标。