Differentiation of Clinical Phenotypes of Inflammatory and Neuropathic Ocular Pain Conditions with Morphologic Measures and Functional Brain Imaging

通过形态学测量和功能性脑成像区分炎症性和神经性眼痛的临床表型

• 批准号: 10707201
• 负责人: Eric Alan Moulton
• 金额: $ 94.73万
• 依托单位: BOSTON CHILDREN'S HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-30 至 2027-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10707201
• 关键词: Adult; Affect; Affective; Age; Amygdaloid structure; Anatomy; Animal Model; Anterior; Anti-Inflammatory Agents; Brain; Brain Stem; Brain imaging; Brain region; Central Nervous System; Chronic; Classification; Clinical; Clinical Research; Complex; Confocal Microscopy; Cornea; Data; Diagnosis; Diffusion Magnetic Resonance Imaging; Disease; Distress; Emotions; Event; Exhibits; Eye; Foundations; Functional Magnetic Resonance Imaging; Future; Goals; Human; Immune; Individual; Inflammation; Inflammatory; Infrastructure; Insula of Reil; Investigation; Knowledge; Lesion; Light; Lubrication; Machine Learning; Magnetic Resonance Imaging; Measures; Mechanics; Mental Health; Microscopy; Modeling; Monitor; Morbidity - disease rate; Morphology; Nerve; Nerve Fibers; Nervous System; Neural Pathways; Neurologic; Neuropathy; Nociception; Pain; Pathology; Pathway interactions; Patient Monitoring; Patients; Peripheral; Peripheral Nerves; Peripheral Nervous System; Persons; Phenotype; Photophobia; Population; Positioning Attribute; Research; Rest; Sensory; Sjogren' s Syndrome; Source; Stains; Stimulus; Structure; Structure of trigeminal ganglion; Symptoms; System; Techniques; Testing; Therapeutic Effect; Translational Research; Trigeminal System; Trigeminal nerve structure; aqueous; base; blood oxygenation level dependent response; brain morphology; central pain; central sensitization; chronic neuropathic pain; chronic pain; clinical decision-making; clinical diagnosis; clinical diagnostics; clinical phenotype; comorbidity; density; diagnostic biomarker; disability; disease phenotype; effective therapy; eye dryness; improved; in vivo; inflammatory pain; lens; multimodality; nerve supply; neural circuit; neural network; neuroimaging; neuromechanism; ocular pain; pain processing; pain symptom; painful neuropathy; physical conditioning; programs; reflectance confocal microscopy; response; sex; somatosensory; spontaneous pain; tissue injury; tool; white matter

Chronic ocular pain is a highly distressing symptom as its occurrence results in high morbidity without effective treatment. Patients with dry eye (DE) commonly have painful ocular symptoms, yet the neural mechanisms underlying this type of pain may include inflammatory (as in Sjogren's syndrome) and/or neuropathic contributors (as in neuropathic ocular pain [NOP]). The cornea is innervated by the trigeminal nerve, which conveys peripheral input to the central nervous system. Using neuroimaging to evaluate peripheral nerves to supraspinal structures, we propose to define the structural and functional differences in the trigeminal circuit that differentiate inflammatory and neuropathic pain. In aim 1, we will determine trigeminal nerve pathology in persons with Sjogren's vs. NOP vs. controls using quantitative sensory testing (QST), in vivo corneal nerve microscopy (IVCM), and diffusion tensor imaging (DTI). In aim 2, we will define differences between Sjogren's vs. NOP in the central nervous system by comparing functional responses to light-induced pathways associated with photophobia using fMRI, and structure using MRI and DTI. This study is likely to yield (1) structural and functional diagnostic markers to differentiate inflammatory and neuropathic ocular pain with neuroimaging, and (2) evince a neurological source of pain symptoms with neuropathic ocular pain. Data generated from this investigation may be used to improve the diagnosis and monitoring of patients suffering from chronic ocular pain, and provide an objective marker to base clinical decision making.

慢性眼痛是一种非常令人痛苦的症状，因为如果没有有效的治疗，其发生会导致高发病率。 治疗。干眼症 (DE) 患者通常会出现眼部疼痛症状，但神经机制 此类疼痛的潜在原因可能包括炎症（如干燥综合征）和/或神经性疼痛 因素（如神经性眼痛 [NOP]）。角膜受三叉神经支配， 将外周输入传送至中枢神经系统。使用神经影像学评估周围神经 脊柱上结构，我们建议定义三叉神经回路的结构和功能差异 区分炎症性疼痛和神经性疼痛。在目标 1 中，我们将确定三叉神经病理学 使用定量感觉测试 (QST)、体内角膜神经对干燥症患者、NOP 患者与对照组进行比较 显微镜（IVCM）和扩散张量成像（DTI）。在目标 2 中，我们将定义 Sjogren 之间的差异 通过比较对光诱导途径的功能反应来对比中枢神经系统中的 NOP 使用 fMRI 与畏光相关，使用 MRI 和 DTI 与结构相关。这项研究可能会产生 (1) 结构和功能诊断标记物，用于区分炎症性和神经性眼痛 神经影像学，(2) 显示疼痛症状的神经源性神经性眼痛。数据 这项调查的结果可用于改善患者的诊断和监测 慢性眼痛，并为临床决策提供客观标记。