Chronic Pain, Motor Output and Motor Learning in Knee Osteoarthritis

膝骨关节炎的慢性疼痛、运动输出和运动学习

• 批准号: 9099156
• 负责人: KATHERINE S RUDOLPH
• 金额: $ 44.8万
• 依托单位: UNIVERSITY OF NEW ENGLAND
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-04-01 至 2020-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9099156
• 关键词: Address; Aerobic; Affect; Age; Americas; Arthritis; CNS processing; Caring; Centers for Disease Control and Prevention (U.S.); Characteristics; Cognitive Therapy; Degenerative polyarthritis; Disease; Dyskinetic syndrome; Escalator; Exercise; Fright; Goals; Healed; Health; Institute of Medicine (U.S.); Intervention; Joints; Knee; Knee Osteoarthritis; Knee joint; Lead; Learning; Measures; Methods; Mind-Body Intervention; Motion; Motor; Motor output; Movement; Muscle; Nervous system structure; Neuraxis; One-Step dentin bonding system; Outcome; Pain; Pathology; Patients; Pattern; Perception; Peripheral; Physical therapy; Physiologic pulse; Population; Prevention; Process; Quality of life; Rehabilitation therapy; Relaxation; Reporting; Research; Self Efficacy; Sensory Process; Signal Transduction; Source; Specialist; Stimulus; Time; Tissues; Training; Training Programs; Walking; articular cartilage; central sensitization; chronic pain; common symptom; conditioning; daily functioning; design; education research; experience; hamstring; healing; improved; improved functioning; insight; joint destruction; knee replacement arthroplasty; meetings; middle age; motor control; motor learning; neuromuscular; programs; public health relevance; quadriceps muscle; response; sensory feedback; sex; success

 DESCRIPTION (provided by applicant): By 2030, it is estimated that 67 million people will have osteoarthritis (OA) in the US and the majority of them will have OA in the knee that begins in middle age. Patients endure pain for many years before they have a total knee replacement. The number of years that knee OA patients endure pain takes a toll on their knee function and quality of life but it also impacts how the nervous system processes pain signals. Central sensitization of pain is a heightened response to painful stimuli that is a protective mechanism designed to allow the body to heal. Under normal circumstances, central sensitization subsides when tissue healing is complete. However, sometimes central sensitization persists and pain is exaggerated or no longer originates from a peripheral source. This abnormal sensory processing can lead to misdiagnosis and poor outcomes to treatments because the source of the pain is in the central nervous system not in peripheral tissues. Central sensitization of pain has been demonstrated in people with knee OA and it is exacerbated by another anomalous pain mechanism: reduced conditioned pain modulation (CPM). CPM involves the application of a painful "conditioning stimulus" that elicits a reduction in the perception of pain. The presence of central sensitization and reduced conditioned pain modulation can make knee OA much harder to treat, however clinicians are now augmenting traditional physical therapy interventions with treatments like cognitive behavioral therapy and mind-body treatments that can influence how the central nervous system processes the pain signals. Unfortunately, those interventions do not influence the movement patterns used by people that can hasten joint degeneration including reduced knee motion and higher muscle co-contraction combined with buckling. These movements produce greater loads and higher shear forces in the knee that are particularly detrimental to articular cartilage. Recently physical therapy interventions have been developed to address the abnormal movement and muscle activation patterns but none have been shown to be any more effective than traditional aerobic or strengthening exercises. This may be due to deficits in the ability to learn new motor programs to stabilize the knee which is highly plausible considering that motor output and motor learning rely on accurate sensory feedback that we know is impaired in people with knee OA. This study will investigate the presence of central sensitization and reduced CPM and their influence on motor adaptation and learning in this population. The results will provide valuable insight into motor control that can be used to furthe develop treatments that will improve knee function while slowing progress of the disease.

 描述（由申请人提供）：预计到 2030 年，美国将有 6700 万人患有骨关节炎 (OA)，其中大多数人的膝盖骨关节炎始于中年，患者多年来一直忍受着疼痛。他们进行全膝关节置换术。膝关节骨关节炎患者忍受疼痛的年数会影响他们的膝关节功能和生活质量，但也会影响神经系统处理疼痛信号的中枢敏感度。对疼痛刺激的许多反应是一种旨在让身体愈合的保护机制，在正常情况下，当组织完全愈合时，中枢敏化会消退，但有时中枢敏化会持续存在，并且疼痛会被夸大或不再源自外周源。这种异常的感觉处理可能会导致误诊和治疗效果不佳，因为疼痛的根源在于中枢神经系统而不是周围组织。膝关节骨关节炎患者的疼痛中枢敏感化已得到证实。另一种异常疼痛机制加剧：条件性疼痛调节（CPM）减少，涉及应用疼痛的“条件性刺激”，引起疼痛感知的减少。中枢敏化和条件性疼痛调节的减少可以导致膝骨关节炎。治疗难度要大得多，但现在人们更喜欢通过认知行为疗法和身心治疗等方法来增强传统的物理治疗干预措施，这些治疗措施可以影响中枢神经系统处理疼痛信号的方式，不幸的是，这些干预措施不会影响患者使用的运动模式。加速关节退化的人，包括减少膝盖运动和更高的肌肉共同收缩以及屈曲，这些运动会在膝盖中产生更大的负荷和更高的剪切力，这对关节软骨特别有害，最近已经开发出物理治疗干预措施来解决这一问题。异常的运动和肌肉激活模式，但没有被证明比传统的有氧运动或力量训练更有效，这可能是由于学习新的运动程序来稳定膝盖的能力存在缺陷，这是非常合理的。 考虑到运动输出和运动学习依赖于准确的感觉反馈，而我们知道膝关节骨关节炎患者的感觉反馈受到损害，本研究将调查中枢敏化和 CPM 降低的情况及其对这一人群运动适应和学习的影响。提供对运动控制的宝贵见解，可用于进一步开发改善膝关节功能同时减缓疾病进展的治疗方法。