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) 的一种特别麻烦的继发后果，影响着大约 40% 的 SCI 患者。尽管 SCI 相关神经性疼痛的患病率很高，而且对康复工作也有影响，但目前对此类疼痛的治疗往往无效。中枢神经性疼痛的更成功干预措施的开发受到以下事实的限制：造成此类疼痛的机制尚不清楚，并且尚未建立明确的诊断和结果工具。定量感觉测试（QST）允许对人类受试者的体感处理机制进行无创评估，最近被提倡作为研究神经性疼痛的潜在关键工具，包括在评估中帮助验证持续疼痛的评级治疗效果，以及将研究从动物模型成功转化为临床治疗范例。拟议试点项目的目标是检查特定 QST 措施的效用，这些措施旨在评估热和疼痛综合感觉处理的完整性，以评估 SCI 患者的神经病理性疼痛特征。由于本试点研究中采用的方法已在数量非常有限的出版物中报道，因此进行该试点项目的理由是为下述假设提供初步支持，这将指导完整研究方案的设计彻底验证这些 QST 技术对 SCI 神经病理性疼痛的作用。 目标 1：检查 SCI 患者热伤害刺激的空间整合程度与神经性疼痛的存在之间的关系。通过要求受试者评价使用一个热探针（面积 9cm2）和并排使用两个热探针（总面积 18cm2）传递的不同温度的热刺激所产生的疼痛强度，来测量刺激-反应关系。将通过比较受试者之间小刺激区域（一个探针）和大刺激区域（两个探针）的疼痛强度等级差异来评估空间总和。我们假设，与没有疼痛的 SCI 参与者相比，患有 SCI 和神经性疼痛的参与者在两种刺激大小（一个探针与两个探针）之间的疼痛评级差异更大（即更大的空间总和），这表明在患有神经性疼痛的人身上整合跨空间的有害输入。 目标 2：比较患有神经性疼痛的 SCI 患者和没有疼痛的 SCI 患者对“热烧烤”刺激的知觉反应。热烧烤刺激将用于评估热和疼痛整合过程。热烤架通常由许多同时呈现的交错的暖（40°C）和冷（20°C）刺激条组成，当呈现在体感功能完好的人的皮肤上时，会产生矛盾的“灼痛”感觉。人们认为，这种由热烧烤引起的疼痛体验对于患有神经性疼痛的人来说是不正常的。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 SCI 但不患有神经性疼痛的患者中获得热烤架产生的疼痛阈值。据推测，患有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，这表明来自温暖和凉爽感觉通路的信息的正常整合在患有神经性疼痛的人中被破坏。 拟议的试点研究的结果将深入了解可能与神经性疼痛经历相关的特定体感系统机制，并将为未来的研究提供支持，旨在充分验证这些 QST 技术作为潜在诊断和结果测量的用途SCI 中的神经性疼痛。