Disrupted Spatial and Temporal Nociceptive Filtering in Adolescents with and Risk for Overlapping Pain Conditions

患有重叠疼痛的青少年的空间和时间伤害性过滤被破坏以及存在重叠疼痛的风险

• 批准号: 10592728
• 负责人: Christopher D King
• 金额: $ 53.66万
• 依托单位: CINCINNATI CHILDRENS HOSP MED CTR
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-08-01 至 2023-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10592728
• 关键词: Abdominal Pain; Absence of pain sensation; Adolescent; Adult; Age; Awareness; Back; Behavioral; Childhood; Chronic; Clinic; Control Groups; Development; Dimensions; Early identification; Enrollment; Event; Female; Foundations; Future; Gastroenterology; Goals; Individual; Individual Differences; Knowledge; Life; Longevity; Medical center; Methods; Migraine; Musculoskeletal; Musculoskeletal Pain; Neuraxis; Neurosciences; Nociception; Pain; Pain Research; Pain management; Participant; Patients; Pattern; Phenotype; Pilot Projects; Positioning Attribute; Prevention; Public Health; Quality of life; Recording of previous events; Research; Rheumatology; Risk; Risk Factors; Sampling Studies; Sensory; Sleep disturbances; Stimulus; Stress; Testing; Time; United States National Institutes of Health; Youth; base; biopsychosocial; chronic pain; chronic painful condition; clinical infrastructure; clinically relevant; conditioned pain modulation; daily functioning; design; disability; experience; high risk; innovation; insight; longitudinal design; multidisciplinary; patient subsets; prevent; programs; prospective; psychosocial; recruit; screening; sex; somatosensory

PROJECT ABSTRACT While localized primary pain conditions are prevalent in youth, a significant subset of these patients experience multiple pain conditions and meet the criteria for chronic overlapping pain conditions (COPCs). COPCs have a marked negative impact on daily functioning and quality of life in youth and carry a high risk for continued pain and disability into adulthood. The underlying factors contributing to the development and persistence of COPCs in youth are unknown. The current proposal offers an innovative and previously unexplored approach to determine whether disruptions in spatial (concurrent noxious stimuli across the body) and temporal (noxious stimuli presented over time) filtering of nociceptive processing, reflecting pain amplification (e.g., increased facilitation and/or reduced inhibition), contribute to COPCs. Several quantitative sensory testing methods are uniquely positioned to probe disruptions in nociceptive filtering across spatial (spatial summation, SS; conditioned pain modulation, CPM) and temporal (temporal summation, TS; offset analgesia, OFA) domains. Our recent pilot studies found evidence for greater disruptions in spatial (CPM) and temporal (TS) filtering in youth with COPCs. Our primary objective is to determine if spatial and temporal filtering of nociceptive information differentiate youth with COPCs from those with localized pain and healthy controls and determine whether distinct profiles of disrupted nociceptive processing are associated with the transition of localized pain to COPCs. To accomplish this, the current study will leverage expertise and a vast clinical infrastructure (Migraine, Gastroenterology, Rheumatology and Pain Management clinics) at large pediatric medical center to enroll 140 youth with a localized pain condition (migraine, abdominal pain, local MSK), and 140 youth with COPC’s. We will also recruit 140 healthy youth to serve as a control group. Following initial phenotyping to delineate disruptions in spatial and temporal dimensions of nociceptive processing (Aim 1), participants will be assessed for changes in pain status (localized to COPCs) every three months for one year (Aim 2). In Aim 1, we hypothesize that youth with COPCs will show disrupted spatial (reflected by reduced CPM and enhanced SS) and temporal (reflected by enhanced TS and reduced OFA) processing compared to youth with localized pain and healthy controls. These findings will delineate specific disruptions of nociceptive processing in patients with COPCs. For Aim 2, we hypothesize that a subset of youth with localized pain and disrupted spatial and temporal filtering will develop COPCs. We will examine the stability of spatial and temporal filtering at clinically relevant timepoints (3-, 6-, and 12-months). We will also explore whether the disrupted filtering and the transition to COPCs are influenced by factors including concomitant treatments. Our research will provide the first insight into the presence and impact of disrupted nociceptive filtering related to COPCs and its naturalistic progression from localized pain. This information will be critical in identifying risk patterns that can be useful in prevention of progression to COPCs and mitigating long-term risk.

项目摘要 虽然局部初级疼痛状况在青年中很普遍，但这些患者的很大一部分经历 多种疼痛状况并符合慢性重叠疼痛条件（COPC）的标准。 COPC有一个 对年轻人的日常运作和生活质量的显着负面影响，并承担持续疼痛的高风险 和残疾到成年。有助于发展和持久性的基本因素 青年中的COPC是未知的。当前的建议提供了一种创新且以前出乎意料的方法 确定空间中的破坏（同时存在的有害刺激）和暂时的（有害）（有害） 随着时间的推移提出的刺激）过滤伤害性处理，反映了疼痛的扩增（例如，增加 促进和/或减少抑制），有助于COPC。几种定量的感觉测试方法是 独特地定位于探测在空间上的伤害性滤波中的探测破坏（空间总和，SS； 条件疼痛调节，cpm）和临时（时间求和，ts;偏移镇痛，ofa）域。 我们最近的试点研究发现，空间（CPM）和临时（TS）过滤的证据表明 青年与COPC。我们的主要目的是确定伤害感受的空间和临时过滤 信息将青年与COPC与局部疼痛和健康对照的人区分开，并确定 伤害性处理的不同概况是否与局部疼痛的过渡有关 到COPC。为此，当前的研究将利用专业知识和庞大的临床基础设施 （偏头痛，胃肠病学，风湿病学和疼痛管理诊所）在大型儿科医学中心 招募140名患有局部疼痛状况的青年（偏头痛，腹痛，当地MSK）和140名年轻人 COPC的。我们还将招募140名健康青年作为对照组。在初始表型之后 描绘伤害感受处理的空间和临时维度的破坏（AIM 1），参与者将是 评估每三个月的疼痛状况变化（本地化为COPC）一年（AIM 2）。在AIM 1中， 我们假设患有COPC的青年会显示出干扰的空间（通过CPM减少并增强反映 SS）和临时（通过增强的TS和减少）处理与局部化的年轻人相比 疼痛和健康对照。这些发现将描述对伤害性处理的特定干扰 患有COPC的患者。对于AIM 2，我们假设一部分患有局部疼痛并破坏的年轻人 空间和临时过滤将发展COPC。我们将检查空间和临时过滤的稳定性 在临床上相关的时间点（3-，6和12个月）。我们还将探讨中断的过滤和 向COPC的过渡受到包括伴随治疗的因素的影响。我们的研究将提供 首先了解与COPC及其ITS有关的伤害性过滤的存在和影响 局部疼痛的自然主义进展。这些信息对于确定可以的风险模式至关重要 可用于预防向COPC的进展并减轻长期风险。