CRCNS: Model-Based Characterization of spinal cord stimulation for pain

CRCNS：基于模型的脊髓刺激疼痛表征

基本信息

批准号：
10641966
负责人：
SCOTT F LEMPKA
金额：
$ 31.14万
依托单位：
UNIVERSITY OF MICHIGAN AT ANN ARBOR
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：
2019-09-01 至 2024-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10641966
关键词：
Adult American Analgesics Anatomy Brain Clinical Complex Computer Models Cross-Over Studies Detection Diabetes Mellitus Double-Blind Method Effectiveness Electrodes Elements Engineering Fiber Future Goals Health Heart Diseases Implant Instruction Intervention Knowledge Link Location Malignant Neoplasms Measurement Measures Medical Imaging Modeling Nature Neurons Neurostimulation procedures of spinal cord tissue Opioid Analgesics Outcome Outcome Measure Pain Pain Measurement Pain Threshold Pain intensity Pain management Pain quality Pathway interactions Patients Persons Physiologic pulse Physiological Placebo Control Placebo Effect Population Postoperative Period Principal Investigator Protocols documentation Quality of life Randomized Refractory Research Sales Sensory Source Spinal Spinal Cord Spine pain Stimulus Techniques Technology Testing Therapeutic Time United States Vertebral column Work antinociception central pain chronic pain chronic pain management clinical implementation conditioned pain modulation conditioning conventional therapy cost electric field improved individualized medicine innovation interpatient variability neural opioid epidemic overtreatment pain inhibition pain model pain perception pain processing pain reduction pain relief pain sensitivity pain signal placebo controlled study pressure prevent programs response somatosensory success vibration

项目摘要

Program Director/Principal Investigator (Last, First, Middle}: Lempka, Scott F PROJECT SUMMARY (See instructions}: Chronic pain is a major health problem in the United States and costs the nation upwards of $635 billion a year- more than cancer, heart disease and diabetes combined. Due to its debilitating nature and widespread impact, chronic pain is complex and challenging to treat. Unfortunately, conventional treatments have limited effectiveness for many people with severe chronic pain. Opioid analgesics are frequently prescribed despite the lack of evidence supporting their long-term use to treat chronic pain, and the associated opioid epidemic threatening the United States. Nonpharmacologic approaches, such as complementary and neurostimulation therapies, may offer better alternatives for chronic pain management. Spinal cord stimulation (SCS) is one type of neurostimulation therapy that can be considered for patients who are refractory to other treatment options. However, the outcomes of SCS and other neurostimulation therapies remain mixed. These variable outcomes can be contributed to a potential "placebo" effect and a poor understanding of their mechanisms of action. The goal of this project is to identify the anti-nociceptive effects of SCS by conducting a placebo-controlled study in patients undergoing SCS for chronic pain management. Spinal and supraspinal pain processing will be assessed with outcome measures related to several aspects of pain and quantitative sensory testing of pain sensitivity. These measurements will be combined with patient-specific computational models of SCS that will include: 1) electric-field models to estimate the direct neural response to SCS and 2) spinal cord circuit models to estimate the effects of SCS on pain processing. Therefore, this project will implement a systematic, well-controlled, patient-specific approach to investigate segmental spinal and central pain-processing mechanisms and the placebo effect associated with SCS. This approach is necessary to improve our understanding of chronic pain and how to treat it. II will apply cutting-edge computational modeling techniques to answer critical scientific questions within a clinical setting. The results of this project will improve scientific understanding of neurostimulation for chronic pain, help optimize and individualize current technologies, and innovate future therapies that improve clinical outcomes. RELEVANCE (See instructions): Neurostimulalion therapies, such as spinal cord stimulation, can provide nonpharmacologic treatment options to the millions of Americans suffering from pain. However, these neurostimulation therapies can fail to provide adequate pain relief in a large number of people. Therefore, this project will combine detailed computational models with measures of pain modulation in patients to investigate therapeutic mechanisms of neurostimulation and provide knowledge necessary to improve its effectiveness for pain management.

项目总监/首席研究员（姓、名、中）：Lempka, Scott F 项目摘要（参见说明}：慢性疼痛是美国的一个主要健康问题，每年给国家造成的损失高达 6350 亿美元年——超过癌症、心脏病和糖尿病的总和。由于其使人衰弱的性质和慢性疼痛影响广泛，治疗起来很复杂且具有挑战性。不幸的是，传统的对于许多患有严重慢性疼痛的人来说，治疗的效果有限。阿片类镇痛药是尽管缺乏证据支持长期使用它们来治疗慢性疼痛，但仍经常开处方，并且相关的阿片类药物流行病威胁着美国。非药物方法，例如补充疗法和神经刺激疗法可能为慢性疼痛管理提供更好的替代方案。脊髓刺激（SCS）是患者可以考虑的一种神经刺激疗法对其他治疗方案无效的人。然而，SCS 和其他神经刺激的结果治疗方法仍然混杂。这些可变的结果可能会导致潜在的“安慰剂”效应和对它们的作用机制了解甚少。该项目的目标是确定抗伤害药物通过对接受 SCS 治疗慢性疼痛的患者进行安慰剂对照研究来了解 SCS 的影响管理。将通过与以下相关的结果测量来评估脊柱和脊柱上的疼痛处理疼痛的几个方面和疼痛敏感性的定量感觉测试。这些测量结果将是与患者特定的 SCS 计算模型相结合，其中包括：1）电场模型估计对 SCS 的直接神经反应和 2) 脊髓回路模型来估计 SCS 的影响关于疼痛处理。因此，该项目将实施系统的、控制良好的、针对患者的研究节段性脊柱和中枢疼痛处理机制以及安慰剂效应的方法与 SCS 相关。这种方法对于提高我们对慢性疼痛以及如何缓解疼痛的理解是必要的。治疗它。 II 将应用尖端的计算建模技术来回答关键的科学问题在临床环境中。该项目的结果将提高对神经刺激的科学理解针对慢性疼痛，帮助优化和个性化当前技术，并创新未来的治疗方法改善临床结果。相关性（参见说明）：神经刺激疗法，例如脊髓刺激，可以提供非药物治疗为数百万遭受痛苦的美国人提供选择。然而，这些神经刺激疗法可能会失败为大量人群提供充分的疼痛缓解。因此，本项目将结合详细测量患者疼痛调节的计算模型以研究治疗机制神经刺激并提供必要的知识以提高其疼痛管理的有效性。