Age-Related Differences in Psychophysical and Neurobiological Response to Pain

对疼痛的心理物理和神经生物学反应与年龄相关的差异

• 批准号: 8702449
• 负责人: RONALD L COWAN
• 金额: $ 23.55万
• 依托单位: VANDERBILT UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-07-01 至 2016-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8702449
• 关键词: Acute Pain; Adult; Affect; Affective; Age; Aging; Biological; Blood flow; Brain; Cerebrovascular Circulation; Clinical; Consensus; Cutaneous; Data; Detection; Diagnosis; Elderly; Female; Foundations; Functional Magnetic Resonance Imaging; Future; Goals; Health Care Costs; Individual; Injury; Lateral; Lead; Literature; Magnetic Resonance Imaging; Measures; Medial; Mediating; Medical; Methods; Nervous system structure; Neurobiology; Pain; Pain Measurement; Pain Threshold; Pain management; Pathway interactions; Pattern; Prevalence; Prevention; Process; Psychophysics; Public Health; Quality of life; Reporting; Rest; Risk; Sampling; Sensory; Sensory Thresholds; Sex Characteristics; Sleep disturbances; Spin Labels; Stimulus; Symptoms; System; Woman; age effect; age related; blood oxygen level dependent; chronic pain; enhancing factor; experience; improved; insight; male; men; neural model; neurophysiology; older men; older women; pain inhibition; public health relevance; relating to nervous system; response; sensory stimulus; sex; treatment strategy; young adult

DESCRIPTION (provided by applicant): Poorly treated pain in older adults is a critical public health problem. When compared to young adults, evidence suggests that older adults have more painful diagnoses, have increased sensory thresholds for pain, and are at risk for under treatment of their pain. Sex associated differences in the experience of pain are reported in the literature with women generally experiencing more pain and reporting increased sensitivity. Poorly treated pain leads to many associated symptoms, negatively impacts quality of life, and increases health care costs. Exploring the biological reasons for alterations in pain processing is essential to increasing our understanding about pain in older adults. The paucity of neurobiological evidence to support best practice pain management in older adults places these individuals at risk for poor pain management practices. The goals of this project are to determine sex and age associated psychophysical and neurophysiological differences in the processing of pain. Our pilot data in a sample of 12 male and 12 female (age-matched) healthy older adults (ages 65-81) suggests that in response to thermal pain, increasing age is associated with increased brain activation and reduced unpleasantness only in females. Using psychophysics (to measure sensory threshold and affective unpleasantness) and fMRI blood oxygenation level dependent (BOLD) methods (to measure stimulus-evoked brain activation), we will examine age-associated differences in thermal pain processing and their underlying neurophysiology in a broad range of healthy adults (age 30-89). We will also acquire resting state functional connectivity data for secondary analyses exploring whether resting state connectivity predicts psychophysical and neurophysiological responses to thermal pain. To control for the effects of altered blood flow associated with aging, we will acquire resting state arterial spin labeling MRI (ASL) data to quantify resting cerebral blood flow (CBF). We will interpret findings in the context of a proposed neural model of pain, aging, and sex. Our overall hypothesis is that age-associated nervous system changes lead to alterations in inhibitory circuits that modulate pain associated unpleasantness which place older adults, especially females, at reduced risk for detection of pain upon injury, increased risk for under treatment of pain, and increased risk for chronic pain. Altered sensory and affective processing has implications for age-related and sex-specific pain assessment and management strategies. Recent advancements in assessing experimental pain using fMRI provide a critical foundation for our long-term goals which are to determine how aging affects the psychophysics and neurobiology of pain processing and to use this information as normal baseline data for future R01 studies including older adults with painful conditions to inform improved prevention, assessment, and treatment strategies.

描述（由申请人提供）：老年人治疗疼痛不佳是一个关键的公共卫生问题。与年轻人相比，有证据表明，老年人的诊断更痛苦，疼痛的感觉阈值增加，并且有治疗疼痛的风险。文献中报告了疼痛经历中的性别差异，女性通常会经历更多的疼痛并报告提高敏感性。治疗疼痛不佳会导致许多相关症状，对生活质量产生负面影响，并增加医疗保健成本。探索疼痛处理改变的生物学原因是 对我们对老年人疼痛的理解至关重要。神经生物学证据的缺乏支持老年人最佳实践疼痛管理的情况使这些人面临疼痛管理不良的风险。该项目的目标是确定性别和年龄相关的心理物理和神经生理学差异。我们的试验数据中的12个男性和12名女性（年龄匹配）健康的老年人（65-81岁）的样本表明，在响应热疼痛时，增加年龄与女性仅在女性中增加了脑激活和降低的不愉快性有关。使用心理物理学（测量感觉阈值和情感不愉快）和fMRI血液氧合水平（BOLD）方法（测量刺激诱发的大脑激活），我们将检查与年龄相关的热疼痛处理中的差异及其在广泛的神经生理学中的差异健康的成年人（30-89岁）。我们还将获取静止状态功能连接数据的次级分析，以探索静止状态的连通性是否预测了对热疼痛的心理物理和神经生理学反应。为了控制与衰老相关的血流改变的影响，我们将获取静息状态动脉自旋标记MRI（ASL）数据以量化静息脑血流（CBF）。我们将在提出的疼痛，衰老和性别的神经模型的背景下解释发现。我们的总体假设是，与年龄相关的神经系统的变化导致抑制性回路的改变，这些抑制性回路调节疼痛相关的不愉快性，这使老年人，尤其是女性，降低了受伤后疼痛的风险，疼痛治疗的风险增加，并增加慢性疼痛的风险。改变的感觉和情感处理对与年龄相关的性别和性别特定的疼痛评估和管理策略具有影响。使用fMRI评估实验性疼痛的最新进展为我们的长期目标提供了关键的基础，这是确定衰老如何影响疼痛处理的心理物理学和神经生物学，并将这些信息用作正常基线数据，用于未来的R01研究，包括老年人，包括痛苦的老年人为改进的预防，评估和治疗策略提供信息的条件。