Sensory Function and Chronic Pain in Cerebral Palsy

脑瘫的感觉功能和慢性疼痛

基本信息

批准号：
10208563
负责人：
FRANK J SYMONS
金额：
$ 52.44万
依托单位：
UNIVERSITY OF MINNESOTA
依托单位国家：
美国
项目类别：
财政年份：
2021
资助国家：
美国
起止时间：
2021-05-14 至 2026-02-28
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10208563
关键词：
Acute Address Adolescent Affect Appearance Biological Markers Caring Cerebral Palsy Characteristics Child Childhood Clinical Clinical assessments Complex Data Data Set Decision Making Developmental Disabilities Discrimination Electroencephalography Epidemiology Epilepsy Etiology Fiber Functional disorder Future Genetic Grouping Guidelines Health Health Care Costs Heterogeneity Impairment Individual Inflammation Inflammatory Literature Logic Measurement Measures Mechanics Medical Modality Modeling Motor Neuraxis Neurodevelopmental Disability Neurodevelopmental Disorder Nociception Operative Surgical Procedures Outcome Outcome Study Pain Pain Measurement Pain Research Pain management Patients Perception Phenotype Population Protocols documentation Proxy Public Health Quality of life Recording of previous events Reporting Reproducibility Research Sampling Scientific Advances and Accomplishments Sensorimotor functions Sensory Severities Shapes Standardization Stress Subgroup Tactile Techniques Testing Texture Time Translating Validation Work base chemokine chronic neuropathic pain chronic pain clinical care cytokine demographics design disability high risk improved individual variation loss of function novel novel strategies pain outcome postnatal saliva sample secondary outcome sensory mechanism sensory stimulus sex tool

项目摘要

Scientific advances from pain research in basic models and chronic pain populations are rarely translated and applied to improve our clinical understanding of pain and disability among individuals with significant intellectual, motor, and communicative impairments associated with neurodevelopmental disorders. Despite the well document burden of chronic pain in cerebral palsy (CP), the most common cause of pediatric-onset lifelong motor and developmental disability, there is relatively little known about sensory function in relation to chronic pain. The heterogeneity in CP etiology, pathophysiology, and clinical appearance suggests new approaches may be warranted to identify measureable phenotypic patient characteristics predictive of individual variation in chronic pain outcomes. Current pain assessment approaches used in CP are limited in their ability to subgroup CP patients in relation to sensory function that may be relevant for understanding pathophysiological pain mechanisms. Most of the sensory testing research conducted with CP, while important and not in question, has relied on sensory stimuli designed to assess impaired discriminative tactile abilities such as two-point discrimination, texture and shape perception reflecting large sensory fiber afferent function. There has been little work incorporating sensory testing approaches that simultaneously evaluate loss and gain of sensory function reflecting both large and small fiber afferent integrity. The specific purpose of this application is to address the limited scientific understanding of sensory function in CP to ultimately reduce the burden of chronic pain. As a first step to close the gap between the well documented pain burden in CP and the relatively unexplored pain mechanisms in CP we are proposing to investigate an objective standardized (protocol-based) measurement approach by extending the application of a modified quantitative sensory testing (QST) protocol to characterize and compare sensory function in children with CP with and without chronic pain. Our reasoning is as follows. First, comparing sensory function between chronic pain and no chronic pain groups has the potential to reveal differences in underlying tactile/nociceptive sensory function with high relevance for improving our understanding of chronic pain in CP and other severe IDD populations. Second, applying QST to a large sample of children and adolescents with CP will provide the basis for investigating sensory function in relation to individual and clinical characteristics, and health outcomes to identify novel tailoring variables that could guide pain treatment target selection (no such guidelines exist right now). Third, using a protocol-based approach affords an important standardized context in which to investigate nociceptive and inflammatory relevant biomarkers. Finally, the logic of QST provides the basis for exploratory but highly novel tests of sensory subtype constructs (gain, loss of function) informed by the chronic/neuropathic pain research literature as a first step toward creating sensory-function based grouping of chronic pain in CP.

基本模型和慢性疼痛种群中疼痛研究的科学进展很少被翻译，并且用于改善我们对疼痛和残疾的临床理解与神经发育障碍相关的智力，运动和交流障碍。尽管大脑麻痹（CP）的慢性疼痛负担良好，这是小儿发作的最常见原因终身运动和发育障碍，关于感官功能的相对鲜慢性疼痛。 CP病因，病理生理学和临床外观的异质性表明了新的可能有必要采用方法来识别可测量的表型患者特征的预测慢性疼痛结果的个体变化。 CP中使用的当前疼痛评估方法在他们与感官功能相关的CP患者亚组患者的能力，这可能与理解有关病理生理疼痛机制。大多数使用CP进行的感官测试研究，而重要而不是问题的，依赖于旨在评估判别触觉能力受损的感觉刺激例如两点歧视，纹理和形状感知反映了大型感觉纤维传入功能。几乎没有工作结合了同时评估损失和增益的感官测试方法感觉函数反映了大型和小纤维传入完整性。这个的具体目的应用是解决对CP中感觉功能的科学理解有限的，以最终减少慢性疼痛的负担。作为弥合CP中有据可查的疼痛负担之间差距的第一步 CP中相对未开发的疼痛机制我们提议研究目标标准化（基于协议的）测量方法通过扩展修改的定量感觉的应用测试（QST）协议以表征和比较有和没有CP儿童的感官功能慢性疼痛。我们的推理如下。首先，比较慢性疼痛与无慢性疼痛组有可能揭示潜在的触觉/伤害感受函数的差异与我们对CP和其他严重IDD种群中慢性疼痛的理解相关的很高相关性。其次，将QST应用于大量CP的儿童和青少年样本将为研究与个人和临床特征有关的感觉功能，以及健康结果确定可以指导疼痛治疗目标选择的新型剪裁变量（没有正确的准则现在）。第三，使用基于协议的方法提供了一个重要的标准化环境，可以调查伤害性和炎症相关的生物标志物。最后，QST的逻辑为探索性提供了基础但是高度新颖的感觉亚型构建体的测试（增益，功能丧失）由慢性/神经性疗法告知疼痛研究文献是建立基于感官功能的CP慢性疼痛分组的第一步。