Sleep and circadian rhythm disturbances as risk and progression factors for multiple chronic pain conditions

睡眠和昼夜节律紊乱是多种慢性疼痛的风险和进展因素

• 批准号: 10733999
• 负责人: Chung Jung Mun
• 金额: $ 66.02万
• 依托单位: ARIZONA STATE UNIVERSITY-TEMPE CAMPUS
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-06-01 至 2028-02-28
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10733999
• 关键词: 6-sulfatoxymelatonin; Acute; Address; Adult; Affect; Anatomy; Anxiety; Caring; Chronic; Chronic Headaches; Chronic low back pain; Circadian Dysregulation; Circadian Rhythms; Clinical; Depressed mood; Development; Dose; Electroencephalography; Evaluation; Evolution; Exhibits; Fibromyalgia; Genes; Genetic Polymorphism; Health Care Costs; High Prevalence; Home; Hour; Incidence; Individual; Intervention; Knowledge; Laboratory Study; Lead; Link; Measures; Mental Depression; Migraine; Nociceptive Stimulus; Orofacial Pain; Pain; Pain Disorder; Pain Research; Participant; Pathway interactions; Patient Self-Report; Phase; Polysomnography; Population; Prevention approach; Prevention strategy; Proxy; Risk; Risk Assessment; Risk Factors; Role; Seminal; Sensory; Severities; Site; Sleep; Sleep Deprivation; Sleep Fragmentations; Sleep disturbances; Temporomandibular Joint Disorders; Testing; Time; Visit; Work; Wrist; actigraphy; body map; burden of illness; catalyst; chronic pain; chronic painful condition; circadian; coping; diaries; disability; effective intervention; follow-up; improved; indexing; insight; member; modifiable risk; monitoring device; multimodality; novel; pain inhibition; pain-related disability; perceived stress; prevent; prospective; psychological distress; recruit; response; shift work; sleep pattern; statistics; treatment strategy; urinary; wireless

PROJECT SUMMARY Chronic pain affects more than one third of the U.S. population, incurring an annual health care cost of $1 trillion. Some of the most prevalent “idiopathic” pain conditions that frequently co-occur, such as chronic low back pain (cLBP), temporomandibular disorders, and fibromyalgia, are referred to as Chronic Overlapping Pain Conditions (COPCs). Among various COPCs, cLBP has the highest prevalence and is one of the top 10 most disabling conditions worldwide. Unfortunately, having multiple COPCs can further interfere with individuals' adaptive pain coping and exacerbate pain-related disability. However, much focus to date has been placed on individual anatomically-based chronic pain conditions and/or one COPC at a time, while little is known about the mechanisms underlying progression to multiple COPCs. A paradigm shift from anatomy-based approaches to mechanism-based approaches recognizing common and modifiable risk factors of multiple COPCs is crucial in developing effective interventions to treat and prevent multiple COPCs. Emerging evidence suggests that sleep and circadian rhythm disturbances—common clinical features across COPCs—that are modifiable, may serve an important role in progression to multiple COPCs via enhancement of pain amplification and psychological distress, which are two critical proximal determinants of multiple COPCs. For the present study, we propose to recruit a total of 300 participants with cLBP (i.e., 200 with cLBP only vs. 100 with cLBP and other COPCs) at baseline. Among these, 200 participants with cLBP only will be followed for 12 months. Sleep and circadian rhythms will be assessed longitudinally (i.e., baseline and 6-month follow-up) using a cutting- edge wireless EEG sleep monitoring device, 24-hour evaluation of the rhythm of urinary 6-sulfatoxymelatonin (aMT6s), wrist worn actigraphy, and daily sleep diaries. Pain amplification (measured by quantitative sensory testing), psychological distress (measured by well-validated self-report measures), and the number of pain sites (measured by a well-validated pain body map) will be assessed at baseline, and 6- and 12-month follow- up visits. The proposed study will (1) comprehensively characterize the severity of sleep and circadian disturbances using ecologically valid multimodal ambulatory assessments among individuals with single and multiple COPCs; (2) prospectively examine whether baseline and changes (0 to 6 months) in sleep and circadian disturbances are associated with changes (0 to 6 months) in pain amplification and psychological distress; and (3) whether pain amplification and psychological distress at 6 months and their changes (6 to 12 months) are related to progression (6 to 12 months) in the number of pain sites (i.e., a valid proxy measure of multiple COPCs), while controlling for the effects of baseline sleep and circadian disturbances. The findings from this proposed work will provide novel insights into potential mechanistic pathways underlying progression to multiple COPCs, which may inform treatment and prevention strategies for these challenging conditions.

项目摘要 慢性疼痛影响美国人口的三分之一以上，每年的医疗保健费用为 1万亿美元。一些经常同时发生的最普遍的“特发性”疼痛状况，例如慢性低 背痛（CLBP），颞下颌疾病和纤维肌痛被称为慢性重叠疼痛 条件（COPC）。在各种COPC中，CLBP的患病率最高，并且是最十大的十大之一 全球禁用条件。不幸的是，拥有多个COPC可以进一步干扰个人的 自适应疼痛应对和加剧与疼痛有关的残疾。但是，迄今为止已将重点放在 单个基于解剖的慢性疼痛状况和/或一次COPC，而对 发展为多个COPC的机制。基于解剖学的方法的范式转变 对于识别多个COPC的常见和可修改风险因素的基于机制的方法至关重要 在制定有效的干预措施以治疗和预防多个COPC。新兴证据表明 睡眠和昼夜节律疾病 - 跨COPC的常见临床特征 - 可修改，可以 通过加强疼痛扩增和 心理困扰，这是多个COPC的两个关键近端决定者。对于本研究， 我们建议总共招募300名CLBP参与者（即，CLBP仅与CLBP和CLBP 100的参与者 其他COPC）基线。其中，只有200名具有CLBP的参与者将在12个月内进行。睡觉 将使用剪裁 - 边缘无线脑电图监测装置，对尿的6-磺氧蛋白酶节奏的24小时评估 （AMT6S），手腕佩戴行影学和每日睡眠日记。疼痛扩增（通过定量感觉测量 测试），心理困扰（通过验证良好的自我报告措施来衡量）和痛苦数量 将在基线以及6个月和12个月的后续时间内评估位点（通过验证疼痛的身体图测量）。 访问。拟议的研究将（1）全面地表征睡眠和昼夜节律的严重性 使用单个和 多个COPC； （2）前瞻性检查基线和睡眠的变化（0到6个月）和 昼夜节律障碍与疼痛扩增和心理的变化有关（0到6个月） 困扰（3）在6个月时疼痛放大和心理困扰及其变化（6至12 几个月）与疼痛部位数量的进展（6至12个月）有关（即，有效的代理量度 多个COPC），同时控制基线睡眠和昼夜节律干扰的影响。发现 从这项提议的工作中，将提供对进展潜在机械途径的新见解 对于多个COPC，可以为这些挑战条件提供治疗和预防策略。