Mechanism-based treatment approach to chronic tendinopathy pain

基于机制的慢性肌腱病疼痛治疗方法

基本信息

批准号：
9904809
负责人：
Ruth Louise Porter Chimenti
金额：
$ 24.9万
依托单位：
UNIVERSITY OF IOWA
依托单位国家：
美国
项目类别：
财政年份：
2019
资助国家：
美国
起止时间：
2019-07-01 至 2022-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9904809
关键词：
Academic Medical Centers Adult Affect Ankle Area Award Back Biomechanics Biometry Caring Chronic Chronic Care Clinical Collaborations Data Data Collection Debridement Development Development Plans Doctor of Philosophy Education Educational Intervention Evaluation Exercise Fright Future General Population Goals Incidence Individual Injections Injury Institution Intervention Iowa K-Series Research Career Programs Knowledge Learning Local Anesthetics Measures Mentored Clinical Scientist Development Award (K08)Mentors Mentorship Movement Musculoskeletal Musculoskeletal Diseases Neuraxis Neurobiology Nociception Nociceptors Operative Surgical Procedures Orthopedics Pain Pain Research Pain Threshold Pain management Patients Pattern Peripheral Phase Physical therapy Predictive Factor Prevention Process Psychological Factors Psychosocial Factor Randomized Controlled Trials Research Research Training Resolution SF-36 Scientist Severities Site Source Statistical Data Interpretation Techniques Tendinopathy Tendon structure Testing Thinking Time Tissues Training Translating Ultrasonography Universities Work achilles tendon base career career development central sensitization chronic musculoskeletal pain chronic pain clinical care clinical practice conditioned pain modulation design disability effective intervention exercise intervention exercise program experience improved muscle strength novel pain catastrophizing pain inhibition pain reduction physical therapist pressure professor recruit standard of care success targeted treatment tenure track treatment strategy trial design

Academic Medical Centers Adult Affect Ankle Area Award Back Biomechanics Biometry Caring Chronic Chronic Care Clinical Collaborations Data Data Collection Debridement Development Development Plans Doctor of Philosophy Education Educational Intervention Evaluation Exercise Fright Future General Population Goals Incidence Individual Injections Injury Institution Intervention Iowa K-Series Research Career Programs Knowledge Learning Local Anesthetics Measures Mentored Clinical Scientist Development Award (K08)Mentors Mentorship Movement Musculoskeletal Musculoskeletal Diseases Neuraxis Neurobiology Nociception Nociceptors Operative Surgical Procedures Orthopedics Pain Pain Research Pain Threshold Pain management Patients Pattern Peripheral Phase Physical therapy Predictive Factor Prevention Process Psychological Factors Psychosocial Factor Randomized Controlled Trials Research Research Training Resolution SF-36 Scientist Severities Site Source Statistical Data Interpretation Techniques Tendinopathy Tendon structure Testing Thinking Time Tissues Training Translating Ultrasonography Universities Work achilles tendon base career career development central sensitization chronic musculoskeletal pain chronic pain clinical care clinical practice conditioned pain modulation design disability effective intervention exercise intervention exercise program experience improved muscle strength novel pain catastrophizing pain inhibition pain reduction physical therapist pressure professor recruit standard of care success targeted treatment tenure track treatment strategy trial design

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项目摘要

Project Summary/Abstract I am a clinician-scientist committed to performing high quality research on the causes, treatment and prevention of musculoskeletal diseases. As physical therapist with PhD training in orthopaedic biomechanics, I have rigorous training in the evaluation and treatment of how people move in order to reduce tissue injury and pain. An emerging field of research indicates that changes in the central nervous system (CNS) contribute to pain in patients with orthopaedic injuries, such as tendinopathy. Yet the current standard of care for Achilles tendinopathy does not evaluate or treat CNS pain mechanisms. We propose 2 independent studies to test how altered processing within the CNS contributes to chronic Achilles tendinopathy (AT) pain. K99 phase study: Specific Aim 1.1 compares measures of altered central processing in patients with chronic AT to adults without chronic pain; Specific Aim 1.2 determines which indicators of altered central processing persist after a local anesthetic injection eliminates peripheral nociception at the site of AT pain in patients with chronic AT. R00 phase study: Specific Aim 2.1 examines if the addition of pain education to an exercise program for AT is more effective at reducing pain and disability than exercise alone using an randomized controlled trial (RCT) design; Specific Aim 2.2 determines which indicators of altered central processing are improved by the addition of pain education to an exercise intervention. The University of Iowa is a research-intensive university that facilitates my ability to obtain mentorship from leaders in the field of pain research, to collaborate with experts in clinical care and biostatistics, and to work within an academic medical center to facilitate recruitment and data collection. The short-term goals for the K99 phase of this career development award are two-fold: first, to obtain much-needed didactic coursework and experience in the evaluation of pain mechanisms; and second, is to obtain training in the design and conduct of a high quality RCT using an educational intervention in combination with exercise to treat chronic tendinopathy pain. To achieve these goals I have identified 4 key objectives: 1) Gain greater knowledge about the neurobiology of pain mechanisms; 2) Gain experience in the conduct and design of an RCT; 3) Learn about psychological factors that contribute to pain & develop a pain education intervention; and 4) Learn about and participate in statistical analysis of RCT data. The long-term goal for the R00 phase is to implement the RCT techniques learned during the K99 phase. Thus, this career development plan is designed to help me succeed in my career goal as a tenure-track professor in a top-ranked, research-intensive institution. Ultimately, I would like to perform research that can improve clinical care of individuals with chronic musculoskeletal pain, to translate this research to clinical practice, and to train future clinician-scientists.

项目摘要/摘要我是临床医生科学家，致力于对原因，治疗和预防肌肉骨骼疾病。作为骨科生物力学博士培训的物理治疗师，我在评估和治疗人们如何移动以减少组织损伤和治疗方面进行严格的培训疼痛。新兴的研究领域表明中枢神经系统（CNS）的变化有助于骨科损伤患者（例如肌腱病）的疼痛。但是当前的阿喀琉斯护理标准肌腱病不会评估或治疗中枢神经系统疼痛机制。我们提出了2项独立研究，以测试如何中枢神经系统内的加工改变会导致慢性跟腱病（AT）疼痛。 K99阶段研究：特定目标1.1比较慢性患者中心处理改变的度量在没有慢性疼痛的成年人身上；特定目的1.2确定中央处理更改的指标局部麻醉注射后持续存在消除患者AT疼痛部位的周围伤害受伤与慢性。 R00阶段研究：具体目标2.1检查是否在AT的运动计划中增加疼痛教育是否与单独使用随机对照试验（RCT）相比，比单独运动更有效地减轻疼痛和残疾。设计;具体目标2.2确定哪些改变的中央处理指标得到了改善在运动干预中增加疼痛教育。爱荷华大学是一所研究密集于大学，可促进我从疼痛研究领域的领导者与临床护理和生物统计学专家合作，并工作在一个学术医学中心，以促进招聘和数据收集。短期目标该职业发展奖的K99阶段是两个方面：首先，获得急需的教学课程和评估疼痛机制的经验；第二，是要获得设计的培训，使用教育干预措施与锻炼相结合以治疗慢性肌腱病疼痛。为了实现这些目标，我已经确定了4个关键目标：1）获得有关疼痛机制的神经生物学； 2）在RCT的行为和设计方面获得经验； 3）学习关于有助于疼痛和发展疼痛教育干预的心理因素； 4）了解并参与RCT数据的统计分析。 R00阶段的长期目标是实施在K99阶段学习的RCT技术。因此，该职业发展计划旨在帮助我在我的职业生涯中取得了成功，成为一名排名最高的研究密集型机构的任期教授。最终，我想进行研究，以改善患有慢性个人的临床护理肌肉骨骼疼痛，将这项研究转化为临床实践，并培训未来的临床医生。